From the Guidelines
The presence of tear drop cells in a patient's peripheral blood smear is a significant indicator of underlying bone marrow pathology, particularly in myelodysplastic syndromes, and warrants further investigation, including bone marrow biopsy, as recommended by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of myelodysplastic syndromes 1. Tear drop cells, also known as dacryocytes, are abnormally shaped red blood cells that have a teardrop or pear-like appearance with one pointed end. These distinctive cells are typically found in peripheral blood smears and indicate underlying bone marrow pathology, as outlined in the ESMO guidelines, which list tear drop cells as a sign of dysplasia in myelodysplastic syndromes 1. Some key points to consider when evaluating tear drop cells include:
- The presence of tear drop cells can be associated with various conditions, including myelofibrosis, myelodysplastic syndromes, severe megaloblastic anemia, and certain leukemias.
- The formation of tear drop cells is thought to occur when red blood cells are forced to squeeze through fibrotic or crowded bone marrow tissue, causing physical deformation of the normally biconcave disc-shaped cells.
- The percentage of tear drop cells present can sometimes correlate with disease severity, making them a useful diagnostic and monitoring marker in hematologic disorders.
- Treatment depends entirely on the primary condition causing the tear drop cells rather than targeting the cells themselves, as emphasized in the ESMO guidelines 1. In terms of diagnosis, the ESMO guidelines provide a comprehensive overview of the signs of dysplasia in myelodysplastic syndromes, including tear drop cells, and recommend a bone marrow biopsy as a crucial diagnostic tool 1. Overall, the presence of tear drop cells is a significant finding that requires prompt further investigation and management, as outlined in the ESMO clinical practice guidelines 1.
From the Research
Tear Drop Cells
- Tear drop cells, also known as dacryocytes, are teardrop-shaped erythrocytes that can be observed in peripheral blood smears of patients with various conditions, including primary or secondary myelofibrosis, malignant infiltrative disorders of the bone marrow, autoimmune hemolytic anemia (AIHA), and microangiopathic hemolytic anemia (MAHA) 2, 3, 4.
- The presence of tear drop cells in peripheral blood has traditionally been associated with altered marrow architecture, namely myelofibrosis, but studies have shown that they can also be found in patients with AIHA and MAHA without myelofibrosis 3, 4.
- The diagnostic significance of tear drop cells lies in their ability to distinguish between different types of myeloproliferative disorders, such as essential thrombocythemia (ET) and chronic idiopathic myelofibrosis (CIMF) 2, 5.
- Bone marrow histopathology, including the examination of tear drop cells, is an important diagnostic tool for distinguishing specific subtypes of myeloproliferative disorders and should be a mandatory step for entry evaluation and follow-up of patients enrolled in prospective studies and/or clinical trials 5.
Clinical Significance
- Tear drop cells can be found in patients with a range of clinical parameters, including borderline to slight leukocytosis, therapy-refractory anemia, minimal to modest splenomegaly, and an elevated platelet count 2.
- The presence of tear drop cells in peripheral blood can be an indicator of underlying bone marrow pathology, such as myelofibrosis or extramedullary hematopoiesis 2, 4.
- The examination of tear drop cells in bone marrow aspirates and biopsies can provide valuable diagnostic information and help guide treatment decisions 6, 5.