Dacryocytes (Tear-shaped cells): Meaning and Causes | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en charge au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"dacryocytes cellules en larme, dacryocytes my\u00e9lofibrose, dacryocytes frottis sanguin, po\u00efkilocytose dacryocytes, my\u00e9lofibrose primaire, envahissement m\u00e9dullaire dacryocytes, an\u00e9mie dacryocytes Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">H\u00e9matologie & M\u00e9decine interne<\/span>\n <h1>Dacryocytes (teardrop cells)<\/h1>\n\n <div class=\"co-intro\">\n Les dacryocytes \u2014 du grec <em>tears<\/em> (teardrop) - are abnormally deformed red blood cells with a characteristic unipolar elongation in the shape of a teardrop or teardrop, with a rounded tip and a pointed, tapering apex. They belong to the poikilocyte group (abnormally shaped red blood cells) and are distinguished from ovalocytes (elliptocytes) by their marked asymmetry and pointed apex. The presence of dacryocytes on a peripheral blood smear, even in small numbers, is a morphological signal of major clinical importance: it almost always indicates a severe disturbance of medullary architecture, or mechanical stress exerted on erythrocytes as they are forced to pass through fibrous or infiltrated tissue. The mechanism of dacryocyte formation is twofold. On the one hand, during extramedullary erythropoiesis (hematopoiesis outside the normal bone marrow - spleen, liver - occurring when the marrow is fibrotic or invaded), erythroblasts release immature red blood cells which are deformed as they pass through the splenic sinusoids, cross-linking their membrane. On the other hand, in states of medullary fibrosis, mature red blood cells are irreversibly stretched and deformed as they pass through the network of reticulin and collagen fibers that obstruct the medullary sinusoids - they retain this teardrop shape once in the circulation. The presence of numerous dacryocytes on the smear, associated with leukoerythroblastosis (circulating erythroblasts + immature granulocytes in the peripheral blood), constitutes the myelo-phthisic picture - an almost pathognomonic sign of severe bone marrow invasion or fibrosis requiring urgent hematological investigation.\n <\/div>\n\n <h2>M\u00e9canisme de formation et morphologie<\/h2>\n <ul class=\"co-list\">\n <li>M\u00e9canisme m\u00e9canique (fibrose m\u00e9dullaire) : la fibrose de la moelle osseuse (d\u00e9p\u00f4t de fibres de r\u00e9ticuline grade MF-2 \u00e0 MF-3 selon la classification OMS) cr\u00e9e un r\u00e9seau rigide qui d\u00e9forme les globules rouges lors de leur passage dans les sinuso\u00efdes m\u00e9dullaires ; la membrane \u00e9rythrocytaire, \u00e9tir\u00e9e dans une direction, conserve cette d\u00e9formation anisotropique par r\u00e9organisation irr\u00e9versible du cytosquelette (spectrine, actine, prot\u00e9ine 4.1) ; les dacryocytes ainsi form\u00e9s sont plus rigides et ont une dur\u00e9e de vie raccourcie dans la circulation (h\u00e9molyse mod\u00e9r\u00e9e) \u2014 ils sont progressivement \u00e9limin\u00e9s par les macrophages spl\u00e9niques<\/li>\n <li>M\u00e9canisme spl\u00e9nique (\u00e9rythropo\u00ef\u00e8se extram\u00e9dullaire) : lors de la my\u00e9lofibrose ou de l'envahissement m\u00e9dullaire, l'h\u00e9matopo\u00ef\u00e8se se d\u00e9place vers la rate (spl\u00e9nom\u00e9galie my\u00e9lo\u00efde) et le foie (h\u00e9patom\u00e9galie) ; les \u00e9rythroblastes produits en dehors de la moelle lib\u00e8rent des globules rouges dont la maturation membranaire est incompl\u00e8te ; ces cellules sont d\u00e9form\u00e9es par le passage forc\u00e9 \u00e0 travers les cordons de Billroth et les sinuso\u00efdes spl\u00e9niques \u2192 forme en larme irr\u00e9versible ; l'association spl\u00e9nom\u00e9galie + dacryocytes + \u00e9rythroblastes circulants est hautement \u00e9vocatrice de my\u00e9lofibrose primaire<\/li>\n <li>Morphologie au frottis : le dacryocyte est plus grand qu'un globule rouge normal (macrocyte allong\u00e9) ; son extr\u00e9mit\u00e9 arrondie contient l'h\u00e9moglobine principale ; l'extr\u00e9mit\u00e9 effil\u00e9e est p\u00e2le et plus mince ; il faut distinguer les vrais dacryocytes (pointe orient\u00e9e dans une direction variable d'une cellule \u00e0 l'autre) des pseudo-dacryocytes d'artefact (pointes orient\u00e9es dans la m\u00eame direction \u2014 art\u00e9fact de pr\u00e9paration du frottis, notamment en queue de frottis) ; la quantification semi-quantitative sur le frottis : rares (1+), pr\u00e9sents (2+), nombreux (3+), abondants (4+) ; m\u00eame 1+ de dacryocytes vrais sur un frottis bien pr\u00e9par\u00e9 justifie une investigation<\/li>\n <\/ul>\n\n <h2>Causes de dacryocytes \u2014 diagnostic diff\u00e9rentiel<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:220px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Cause<\/th><th>M\u00e9canisme et contexte clinique<\/th><th>\u00c9l\u00e9ments diagnostiques associ\u00e9s<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>My\u00e9lofibrose primaire (MFP)<br><small style=\"font-weight:400;color:#7a8fa0;\">Cause principale \u2014 dacryocytes abondants<\/small><\/td>\n <td>N\u00e9oplasie my\u00e9loprolif\u00e9rative (NMP) Philadelphia-n\u00e9gative \u2014 mutation JAK2 V617F (50\u201360 %), mutation CALR exon 9 (25\u201330 %) ou mutation MPL (5\u20138 %) \u2192 activation constitutive de la voie JAK-STAT \u2192 prolif\u00e9ration clonale des m\u00e9gacaryocytes dysplasiques \u2192 lib\u00e9ration de TGF-\u03b2, PDGF, bFGF \u2192 fibrose progressive de la moelle osseuse (grades MF-0 \u00e0 MF-3) ; incidence 0,5\u20131\/100 000\/an \u2014 pic 65\u201370 ans ; spl\u00e9nom\u00e9galie massive (parfois >20 cm \u2014 sensation de masse abdominale gauche, sati\u00e9t\u00e9 pr\u00e9coce) ; sympt\u00f4mes constitutionnels (fi\u00e8vre, sueurs nocturnes, amaigrissement \u2014 score MPN-SAF) ; dacryocytes abondants (3+\u20134+) + leuco\u00e9rythroblastose caract\u00e9ristiques ; tableau my\u00e9lo-phtisique complet<\/td>\n <td>NFS : an\u00e9mie (Hb souvent <10 g\/dL) + leucocytose ou leucop\u00e9nie + thrombocytose initiale puis thrombop\u00e9nie ; frottis : dacryocytes abondants + \u00e9rythroblastes + my\u00e9locytes\/m\u00e9tamy\u00e9locytes (leuco\u00e9rythroblastose) + macrocytes + hypochromie ; LDH tr\u00e8s \u00e9lev\u00e9e (lyse cellulaire) ; acide urique \u00e9lev\u00e9 (turnover cellulaire) ; biopsie ost\u00e9om\u00e9dullaire (BOM) \u2014 gold standard : fibrose r\u00e9ticulinique (grade MF-2 ou MF-3) + m\u00e9gacaryocytes dysplasiques group\u00e9s en amas ; mutation JAK2\/CALR\/MPL (panel NGS my\u00e9loprolif\u00e9ratif) ; score DIPSS-Plus (pronostic) ; traitement : ruxolitinib (inhibiteur JAK1\/2 \u2014 r\u00e9duit la spl\u00e9nom\u00e9galie et les sympt\u00f4mes \u2014 standard de soins) ; f\u00e9dratinib, pacritinib, momelotinib (inhibiteurs JAK alternatifs) ; allogreffe de cellules souches h\u00e9matopo\u00ef\u00e9tiques (GCSH) si \u00e9ligible \u2014 seul traitement potentiellement curatif<\/td>\n <\/tr>\n <tr>\n <td>My\u00e9lofibrose secondaire<br><small style=\"font-weight:400;color:#7a8fa0;\">\u00c9volution de NMP pr\u00e9existante<\/small><\/td>\n <td>\u00c9volution en my\u00e9lofibrose de la polyglobulie de Vera (PV \u2192 MF post-PV dans 10\u201320 % \u00e0 20 ans) ou de la thrombocyt\u00e9mie essentielle (TE \u2192 MF post-TE dans 5\u201310 % \u00e0 15 ans) ; m\u00eame tableau morphologique que la MFP avec dacryocytes + leuco\u00e9rythroblastose ; ant\u00e9c\u00e9dent de NMP document\u00e9 ; mutation JAK2 quasi constante dans les post-PV<\/td>\n <td>Frottis + BOM + mutation JAK2 ; crit\u00e8res OMS 2022 de transformation en MF post-PV (Barosi) ou post-TE (Barosi) ; traitement similaire \u00e0 la MFP : ruxolitinib, allogreffe GCSH si \u00e9ligible<\/td>\n <\/tr>\n <tr>\n <td>Envahissement m\u00e9dullaire (my\u00e9lo-phtisie)<br><small style=\"font-weight:400;color:#7a8fa0;\">M\u00e9tastases osseuses, h\u00e9mopathies<\/small><\/td>\n <td>Remplacement du tissu h\u00e9matopo\u00ef\u00e9tique normal par des cellules tumorales extrins\u00e8ques \u2192 tableau my\u00e9lo-phtisique : dacryocytes + leuco\u00e9rythroblastose + thrombocytop\u00e9nie ; cancers m\u00e9tastatiques les plus souvent responsables : carcinome mammaire (le plus fr\u00e9quent \u2014 surtout lobulaire), carcinome prostatique, carcinome pulmonaire, carcinome r\u00e9nal, carcinome gastrique, m\u00e9lanome ; h\u00e9mopathies : lymphome (Hodgkin et non Hodgkin \u2014 envahissement m\u00e9dullaire dans 30\u201380 % selon le type) ; leuc\u00e9mie aigu\u00eb (infiltration blastes) ; my\u00e9lome multiple (remplacemen plasmocytaire extensif) ; sarco\u00efdose granulomateuse m\u00e9dullaire (rare)<\/td>\n <td>Frottis : dacryocytes (souvent 1+\u20132+) + \u00e9rythroblastes + cellules anormales parfois visibles (blastes, cellules tumorales \u2014 rares) ; LDH \u00e9lev\u00e9e, phosphatase alcaline \u00e9lev\u00e9e (m\u00e9tastases ost\u00e9oblastiques \u2014 prostate) ; CA 15-3, PSA, ACE selon le primitif suspect\u00e9 ; TDM thoraco-abdomino-pelvien + TEP-FDG ; BOM \u2014 gold standard : cellules m\u00e9tastatiques \u00e0 l'examen anatomopathologique + immunohistochimie (CK, TTF-1, PSA selon le primitif) ; biopsie de la moelle \u00e0 distance du site de ponction habituel (cr\u00eate iliaque) si premi\u00e8re biopsie non contributive<\/td>\n <\/tr>\n <tr>\n <td>An\u00e9mie m\u00e9galoblastique s\u00e9v\u00e8re<br><small style=\"font-weight:400;color:#7a8fa0;\">B12 or folate deficiency<\/small><\/td>\n <td>Dacryocytes de petite taille + ovalocytes + macrocytes + hypersegmentation des polynucl\u00e9aires neutrophiles (PNN \u2014 >5 lobes dans >5 % des PNN) sur le frottis ; m\u00e9canisme : dys\u00e9rythropo\u00ef\u00e8se intra-m\u00e9dullaire par d\u00e9faut de synth\u00e8se de l'ADN \u2192 \u00e9rythroblastes g\u00e9ants (m\u00e9galoblastes) \u2192 globules rouges de morphologie anormale ; association classique avec une pancytop\u00e9nie (macrocytose + leucop\u00e9nie + thrombop\u00e9nie l\u00e9g\u00e8re) ; dacryocytes moins nombreux et moins typiques que dans la my\u00e9lofibrose<\/td>\n <td>Vitamine B12 s\u00e9rique <150 pmol\/L + acide m\u00e9thylmalonique et homocyst\u00e9ine \u00e9lev\u00e9s (marqueurs fonctionnels plus sensibles) ; folates \u00e9rythrocytaires ; anti-facteur intrins\u00e8que (maladie de Biermer \u2014 50\u201370 % de sensibilit\u00e9) ; anti-cellules pari\u00e9tales (70\u201390 % mais peu sp\u00e9cifiques) ; traitement : B12 IM (cyanocobalamine ou hydroxocobalamine) si maladie de Biermer ou malabsorption ; B12 orale 1 000 \u00b5g\/jour si d\u00e9ficit alimentaire<\/td>\n <\/tr>\n <tr>\n <td>Thalass\u00e9mie (formes s\u00e9v\u00e8res)<\/td>\n <td>Pr\u00e9cipitation des cha\u00eenes \u03b1 exc\u00e9dentaires (\u03b2-thalass\u00e9mie) dans les \u00e9rythroblastes \u2192 \u00e9rythropo\u00ef\u00e8se inefficace s\u00e9v\u00e8re + po\u00efkilocytose marqu\u00e9e incluant dacryocytes, cellules cibles, ovalocytes, fragments ; \u03b2-thalass\u00e9mie majeure (Cooley) et \u03b2-thalass\u00e9mie interm\u00e9diaire ; h\u00e9molyse + spl\u00e9nom\u00e9galie + h\u00e9mosid\u00e9rose<\/td>\n <td>NFS : an\u00e9mie microcytaire hypochrome s\u00e9v\u00e8re ; frottis : po\u00efkilocytose majeure (dacryocytes + cellules cibles + ovalocytes + ponctuations basophiles) ; \u00e9lectrophor\u00e8se de l'h\u00e9moglobine (HbF \u00e9lev\u00e9e, HbA absente dans la thalass\u00e9mie majeure) ; ferritine \u00e9lev\u00e9e (h\u00e9molyse + surcharge en fer) ; g\u00e9notypage des g\u00e8nes de globine<\/td>\n <\/tr>\n <tr>\n <td>Causes rares et art\u00e9facts<\/td>\n <td>My\u00e9lofibrose r\u00e9actionnelle secondaire (tuberculose miliaire, histoplasmose, leishmaniose visc\u00e9rale \u2014 Kala-azar) ; h\u00e9moglobine C (dr\u00e9panocytose) ; d\u00e9ficit en pyruvate kinase ; spl\u00e9nectomie (dacryocytes transitoires post-spl\u00e9nectomie) ; art\u00e9fact de frottis (pseudo-dacryocytes orient\u00e9s dans la m\u00eame direction \u2014 cellules en larme de queue de frottis)<\/td>\n <td>Contexte clinique + s\u00e9rologies infectieuses si my\u00e9lofibrose r\u00e9actionnelle suspect\u00e9e ; examen soigneux du frottis (orientation des pointes \u2014 si toutes pointent dans la m\u00eame direction \u2192 art\u00e9fact) ; \u00e9lectrophor\u00e8se de l'h\u00e9moglobine + dosage enzymatique si h\u00e9molyse non expliqu\u00e9e<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Conduite \u00e0 tenir devant des dacryocytes au frottis<\/h2>\n <ul class=\"co-list\">\n <li>Premi\u00e8re \u00e9tape \u2014 confirmer et quantifier : s'assurer que les dacryocytes sont vrais (pointes orient\u00e9es dans plusieurs directions, aspect morphologique typique) et non des art\u00e9facts de queue de frottis (pseudo-dacryocytes orient\u00e9s uniform\u00e9ment) ; noter la pr\u00e9sence et la quantit\u00e9 d'\u00e9rythroblastes circulants (cellules nucl\u00e9\u00e9es \u2014 anormales en dehors de la grossesse et de l'hypoxie s\u00e9v\u00e8re), de formes jeunes granulocytaires (my\u00e9locytes, m\u00e9tamy\u00e9locytes \u2014 tableau leuco\u00e9rythroblastique), de plaquettes g\u00e9antes ou en amas<\/li>\n <li>Deuxi\u00e8me \u00e9tape \u2014 bilan biologique de premi\u00e8re ligne : NFS compl\u00e8te avec diff\u00e9rentiel manuel + r\u00e9ticulocytes ; LDH et acide urique (lyse tumorale et cellulaire) ; bilan h\u00e9patique complet (h\u00e9patom\u00e9galie sur \u00e9rythropo\u00ef\u00e8se extram\u00e9dullaire) ; ferritine (souvent tr\u00e8s \u00e9lev\u00e9e dans la MFP \u2014 marqueur inflammatoire + surcharge en fer) ; vitamine B12 et folates (\u00e9liminer la m\u00e9galoblastose) ; frottis r\u00e9examin\u00e9 par h\u00e9matologue<\/li>\n <li>Troisi\u00e8me \u00e9tape \u2014 imagerie et investigation sp\u00e9cialis\u00e9e : \u00e9chographie abdominale (spl\u00e9nom\u00e9galie \u2014 taille, volume en cm\u00b3) ou TDM abdomino-pelvien ; panel de mutations JAK2 V617F + CALR exon 9 + MPL W515 (NMP) sur sang p\u00e9riph\u00e9rique ; bilan d'extension oncologique si cancer primitif suspect\u00e9 (TDM + TEP-FDG + marqueurs tumoraux) ; orientation vers l'h\u00e9matologue pour biopsie ost\u00e9om\u00e9dullaire (BOM) \u2014 gold standard pour le diagnostic de my\u00e9lofibrose et d'envahissement m\u00e9dullaire<\/li>\n <li>Biopsie ost\u00e9om\u00e9dullaire (BOM) : r\u00e9alis\u00e9e sous anesth\u00e9sie locale \u00e0 la cr\u00eate iliaque post\u00e9ro-sup\u00e9rieure ; fournit : histologie (fibrose r\u00e9ticulinique et collag\u00e9nique \u2014 classification OMS MF-0 \u00e0 MF-3), cellularit\u00e9 m\u00e9dullaire, immunohistochimie (caract\u00e9risation des cellules tumorales m\u00e9tastatiques), cytog\u00e9n\u00e9tique (del(13q), del(20q), +8, +9 \u2014 anomalies fr\u00e9quentes dans les NMP) ; la my\u00e9lofibrose s\u00e9v\u00e8re rend souvent la biopsie aspirative (ponction-aspiration m\u00e9dullaire \u2014 PAM) impossible (moelle s\u00e8che \u2014 dry tap \u2014 pathognomonique de my\u00e9lofibrose avanc\u00e9e)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>La d\u00e9couverte de dacryocytes sur un frottis sanguin doit syst\u00e9matiquement conduire \u00e0 rechercher une <strong>leuco\u00e9rythroblastose<\/strong> (simultaneous presence of erythroblasts + immature granulocyte precursors in peripheral blood). This association\u2014 <strong>tableau my\u00e9lo-phtisique<\/strong> \u2014 indicates a profound disruption of bone marrow architecture and must lead to urgent hematological investigation (JAK2\/CALR\/MPL mutations + bone marrow biopsy) to primarily rule out primary myelofibrosis or metastatic bone marrow infiltration. The isolated presence of 1-2 dacryocytes without leucoerythroblastosis or splenomegaly can sometimes be observed in benign anemias \u2014 their clinical significance is then less but always to be considered in the clinical context.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Signes n\u00e9cessitant une consultation h\u00e9matologique urgente<\/div>\n <p>Consultez sans d\u00e9lai un m\u00e9decin ou un h\u00e9matologue si le frottis sanguin r\u00e9v\u00e8le des dacryocytes nombreux (2+ ou plus) associ\u00e9s \u00e0 : des \u00e9rythroblastes circulants, des granulocytes immatures (leuco\u00e9rythroblastose) ; une spl\u00e9nom\u00e9galie significative \u00e0 l'examen clinique ou \u00e0 l'imagerie ; une pancytop\u00e9nie ou une cytop\u00e9nie inexpliqu\u00e9e ; des sympt\u00f4mes constitutionnels (fi\u00e8vre prolong\u00e9e, sueurs nocturnes abondantes, amaigrissement inexpliqu\u00e9 >10 % en 6 mois) ; une LDH tr\u00e8s \u00e9lev\u00e9e sans cause \u00e9vidente.<\/p>\n <p>Ces \u00e9l\u00e9ments combin\u00e9s constituent un tableau my\u00e9lo-phtisique qui justifie une biopsie ost\u00e9om\u00e9dullaire en urgence relative (dans les 1 \u00e0 4 semaines) pour \u00e9liminer une my\u00e9lofibrose primaire \u00e9volutive ou un envahissement m\u00e9dullaire n\u00e9oplasique.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron interpr\u00e8tent les r\u00e9sultats de frottis sanguin, prescrivent le bilan de premi\u00e8re ligne devant la d\u00e9couverte de dacryocytes (NFS, LDH, ferritine, mutations JAK2\/CALR\/MPL, bilan oncologique si indiqu\u00e9) et orientent vers l'h\u00e9matologue pour biopsie ost\u00e9om\u00e9dullaire selon le tableau clinique. Des consultations sont disponibles dans nos points de service au Qu\u00e9bec ainsi qu'en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un professionnel de sant\u00e9 qualifi\u00e9. La pr\u00e9sence de dacryocytes sur un frottis sanguin doit toujours \u00eatre corr\u00e9l\u00e9e au contexte clinique et interpr\u00e9t\u00e9e par un m\u00e9decin.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron H\u00e9matologie & M\u00e9decine interne Dacryocytes (cellules en larme) Les dacryocytes \u2014 du grec dakryon (larme) \u2014 sont des globules rouges anormalement d\u00e9form\u00e9s pr\u00e9sentant une elongation unipolaire caract\u00e9ristique en forme de larme ou de goutte, avec une extr\u00e9mit\u00e9 arrondie et une extr\u00e9mit\u00e9 effil\u00e9e pointue. Ils… <a href=\"https:\/\/cliniqueomicron.ca\/en\/dacryocytes-cellules-en-larme\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Dacryocytes (Tear-shaped cells): Meaning and Causes | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron","_metasync_otto_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Dacryocytes (cellules en larme) : | Brossard | Clinique Omicron","_metasync_otto_og_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","_metasync_otto_twitter_title":"Dacryocytes (cellules en larme) : | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron","_aioseo_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en charge au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-21T14:53:24+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24490","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. 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\n\t\t\t\t\t\n\n\n\n\nDacryocytes (Tear-shaped cells): Meaning and Causes | Omicron Clinic<\/title>\n<meta name=\"description\" content=\"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en charge au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"dacryocytes cellules en larme, dacryocytes my\u00e9lofibrose, dacryocytes frottis sanguin, po\u00efkilocytose dacryocytes, my\u00e9lofibrose primaire, envahissement m\u00e9dullaire dacryocytes, an\u00e9mie dacryocytes Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">H\u00e9matologie & M\u00e9decine interne<\/span>\n <h1>Dacryocytes (teardrop cells)<\/h1>\n\n <div class=\"co-intro\">\n Les dacryocytes \u2014 du grec <em>tears<\/em> (teardrop) - are abnormally deformed red blood cells with a characteristic unipolar elongation in the shape of a teardrop or teardrop, with a rounded tip and a pointed, tapering apex. They belong to the poikilocyte group (abnormally shaped red blood cells) and are distinguished from ovalocytes (elliptocytes) by their marked asymmetry and pointed apex. The presence of dacryocytes on a peripheral blood smear, even in small numbers, is a morphological signal of major clinical importance: it almost always indicates a severe disturbance of medullary architecture, or mechanical stress exerted on erythrocytes as they are forced to pass through fibrous or infiltrated tissue. The mechanism of dacryocyte formation is twofold. On the one hand, during extramedullary erythropoiesis (hematopoiesis outside the normal bone marrow - spleen, liver - occurring when the marrow is fibrotic or invaded), erythroblasts release immature red blood cells which are deformed as they pass through the splenic sinusoids, cross-linking their membrane. On the other hand, in states of medullary fibrosis, mature red blood cells are irreversibly stretched and deformed as they pass through the network of reticulin and collagen fibers that obstruct the medullary sinusoids - they retain this teardrop shape once in the circulation. The presence of numerous dacryocytes on the smear, associated with leukoerythroblastosis (circulating erythroblasts + immature granulocytes in the peripheral blood), constitutes the myelo-phthisic picture - an almost pathognomonic sign of severe bone marrow invasion or fibrosis requiring urgent hematological investigation.\n <\/div>\n\n <h2>M\u00e9canisme de formation et morphologie<\/h2>\n <ul class=\"co-list\">\n <li>M\u00e9canisme m\u00e9canique (fibrose m\u00e9dullaire) : la fibrose de la moelle osseuse (d\u00e9p\u00f4t de fibres de r\u00e9ticuline grade MF-2 \u00e0 MF-3 selon la classification OMS) cr\u00e9e un r\u00e9seau rigide qui d\u00e9forme les globules rouges lors de leur passage dans les sinuso\u00efdes m\u00e9dullaires ; la membrane \u00e9rythrocytaire, \u00e9tir\u00e9e dans une direction, conserve cette d\u00e9formation anisotropique par r\u00e9organisation irr\u00e9versible du cytosquelette (spectrine, actine, prot\u00e9ine 4.1) ; les dacryocytes ainsi form\u00e9s sont plus rigides et ont une dur\u00e9e de vie raccourcie dans la circulation (h\u00e9molyse mod\u00e9r\u00e9e) \u2014 ils sont progressivement \u00e9limin\u00e9s par les macrophages spl\u00e9niques<\/li>\n <li>M\u00e9canisme spl\u00e9nique (\u00e9rythropo\u00ef\u00e8se extram\u00e9dullaire) : lors de la my\u00e9lofibrose ou de l'envahissement m\u00e9dullaire, l'h\u00e9matopo\u00ef\u00e8se se d\u00e9place vers la rate (spl\u00e9nom\u00e9galie my\u00e9lo\u00efde) et le foie (h\u00e9patom\u00e9galie) ; les \u00e9rythroblastes produits en dehors de la moelle lib\u00e8rent des globules rouges dont la maturation membranaire est incompl\u00e8te ; ces cellules sont d\u00e9form\u00e9es par le passage forc\u00e9 \u00e0 travers les cordons de Billroth et les sinuso\u00efdes spl\u00e9niques \u2192 forme en larme irr\u00e9versible ; l'association spl\u00e9nom\u00e9galie + dacryocytes + \u00e9rythroblastes circulants est hautement \u00e9vocatrice de my\u00e9lofibrose primaire<\/li>\n <li>Morphologie au frottis : le dacryocyte est plus grand qu'un globule rouge normal (macrocyte allong\u00e9) ; son extr\u00e9mit\u00e9 arrondie contient l'h\u00e9moglobine principale ; l'extr\u00e9mit\u00e9 effil\u00e9e est p\u00e2le et plus mince ; il faut distinguer les vrais dacryocytes (pointe orient\u00e9e dans une direction variable d'une cellule \u00e0 l'autre) des pseudo-dacryocytes d'artefact (pointes orient\u00e9es dans la m\u00eame direction \u2014 art\u00e9fact de pr\u00e9paration du frottis, notamment en queue de frottis) ; la quantification semi-quantitative sur le frottis : rares (1+), pr\u00e9sents (2+), nombreux (3+), abondants (4+) ; m\u00eame 1+ de dacryocytes vrais sur un frottis bien pr\u00e9par\u00e9 justifie une investigation<\/li>\n <\/ul>\n\n <h2>Causes de dacryocytes \u2014 diagnostic diff\u00e9rentiel<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:220px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Cause<\/th><th>M\u00e9canisme et contexte clinique<\/th><th>\u00c9l\u00e9ments diagnostiques associ\u00e9s<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>My\u00e9lofibrose primaire (MFP)<br><small style=\"font-weight:400;color:#7a8fa0;\">Cause principale \u2014 dacryocytes abondants<\/small><\/td>\n <td>N\u00e9oplasie my\u00e9loprolif\u00e9rative (NMP) Philadelphia-n\u00e9gative \u2014 mutation JAK2 V617F (50\u201360 %), mutation CALR exon 9 (25\u201330 %) ou mutation MPL (5\u20138 %) \u2192 activation constitutive de la voie JAK-STAT \u2192 prolif\u00e9ration clonale des m\u00e9gacaryocytes dysplasiques \u2192 lib\u00e9ration de TGF-\u03b2, PDGF, bFGF \u2192 fibrose progressive de la moelle osseuse (grades MF-0 \u00e0 MF-3) ; incidence 0,5\u20131\/100 000\/an \u2014 pic 65\u201370 ans ; spl\u00e9nom\u00e9galie massive (parfois >20 cm \u2014 sensation de masse abdominale gauche, sati\u00e9t\u00e9 pr\u00e9coce) ; sympt\u00f4mes constitutionnels (fi\u00e8vre, sueurs nocturnes, amaigrissement \u2014 score MPN-SAF) ; dacryocytes abondants (3+\u20134+) + leuco\u00e9rythroblastose caract\u00e9ristiques ; tableau my\u00e9lo-phtisique complet<\/td>\n <td>NFS : an\u00e9mie (Hb souvent <10 g\/dL) + leucocytose ou leucop\u00e9nie + thrombocytose initiale puis thrombop\u00e9nie ; frottis : dacryocytes abondants + \u00e9rythroblastes + my\u00e9locytes\/m\u00e9tamy\u00e9locytes (leuco\u00e9rythroblastose) + macrocytes + hypochromie ; LDH tr\u00e8s \u00e9lev\u00e9e (lyse cellulaire) ; acide urique \u00e9lev\u00e9 (turnover cellulaire) ; biopsie ost\u00e9om\u00e9dullaire (BOM) \u2014 gold standard : fibrose r\u00e9ticulinique (grade MF-2 ou MF-3) + m\u00e9gacaryocytes dysplasiques group\u00e9s en amas ; mutation JAK2\/CALR\/MPL (panel NGS my\u00e9loprolif\u00e9ratif) ; score DIPSS-Plus (pronostic) ; traitement : ruxolitinib (inhibiteur JAK1\/2 \u2014 r\u00e9duit la spl\u00e9nom\u00e9galie et les sympt\u00f4mes \u2014 standard de soins) ; f\u00e9dratinib, pacritinib, momelotinib (inhibiteurs JAK alternatifs) ; allogreffe de cellules souches h\u00e9matopo\u00ef\u00e9tiques (GCSH) si \u00e9ligible \u2014 seul traitement potentiellement curatif<\/td>\n <\/tr>\n <tr>\n <td>My\u00e9lofibrose secondaire<br><small style=\"font-weight:400;color:#7a8fa0;\">\u00c9volution de NMP pr\u00e9existante<\/small><\/td>\n <td>\u00c9volution en my\u00e9lofibrose de la polyglobulie de Vera (PV \u2192 MF post-PV dans 10\u201320 % \u00e0 20 ans) ou de la thrombocyt\u00e9mie essentielle (TE \u2192 MF post-TE dans 5\u201310 % \u00e0 15 ans) ; m\u00eame tableau morphologique que la MFP avec dacryocytes + leuco\u00e9rythroblastose ; ant\u00e9c\u00e9dent de NMP document\u00e9 ; mutation JAK2 quasi constante dans les post-PV<\/td>\n <td>Frottis + BOM + mutation JAK2 ; crit\u00e8res OMS 2022 de transformation en MF post-PV (Barosi) ou post-TE (Barosi) ; traitement similaire \u00e0 la MFP : ruxolitinib, allogreffe GCSH si \u00e9ligible<\/td>\n <\/tr>\n <tr>\n <td>Envahissement m\u00e9dullaire (my\u00e9lo-phtisie)<br><small style=\"font-weight:400;color:#7a8fa0;\">M\u00e9tastases osseuses, h\u00e9mopathies<\/small><\/td>\n <td>Remplacement du tissu h\u00e9matopo\u00ef\u00e9tique normal par des cellules tumorales extrins\u00e8ques \u2192 tableau my\u00e9lo-phtisique : dacryocytes + leuco\u00e9rythroblastose + thrombocytop\u00e9nie ; cancers m\u00e9tastatiques les plus souvent responsables : carcinome mammaire (le plus fr\u00e9quent \u2014 surtout lobulaire), carcinome prostatique, carcinome pulmonaire, carcinome r\u00e9nal, carcinome gastrique, m\u00e9lanome ; h\u00e9mopathies : lymphome (Hodgkin et non Hodgkin \u2014 envahissement m\u00e9dullaire dans 30\u201380 % selon le type) ; leuc\u00e9mie aigu\u00eb (infiltration blastes) ; my\u00e9lome multiple (remplacemen plasmocytaire extensif) ; sarco\u00efdose granulomateuse m\u00e9dullaire (rare)<\/td>\n <td>Frottis : dacryocytes (souvent 1+\u20132+) + \u00e9rythroblastes + cellules anormales parfois visibles (blastes, cellules tumorales \u2014 rares) ; LDH \u00e9lev\u00e9e, phosphatase alcaline \u00e9lev\u00e9e (m\u00e9tastases ost\u00e9oblastiques \u2014 prostate) ; CA 15-3, PSA, ACE selon le primitif suspect\u00e9 ; TDM thoraco-abdomino-pelvien + TEP-FDG ; BOM \u2014 gold standard : cellules m\u00e9tastatiques \u00e0 l'examen anatomopathologique + immunohistochimie (CK, TTF-1, PSA selon le primitif) ; biopsie de la moelle \u00e0 distance du site de ponction habituel (cr\u00eate iliaque) si premi\u00e8re biopsie non contributive<\/td>\n <\/tr>\n <tr>\n <td>An\u00e9mie m\u00e9galoblastique s\u00e9v\u00e8re<br><small style=\"font-weight:400;color:#7a8fa0;\">B12 or folate deficiency<\/small><\/td>\n <td>Dacryocytes de petite taille + ovalocytes + macrocytes + hypersegmentation des polynucl\u00e9aires neutrophiles (PNN \u2014 >5 lobes dans >5 % des PNN) sur le frottis ; m\u00e9canisme : dys\u00e9rythropo\u00ef\u00e8se intra-m\u00e9dullaire par d\u00e9faut de synth\u00e8se de l'ADN \u2192 \u00e9rythroblastes g\u00e9ants (m\u00e9galoblastes) \u2192 globules rouges de morphologie anormale ; association classique avec une pancytop\u00e9nie (macrocytose + leucop\u00e9nie + thrombop\u00e9nie l\u00e9g\u00e8re) ; dacryocytes moins nombreux et moins typiques que dans la my\u00e9lofibrose<\/td>\n <td>Vitamine B12 s\u00e9rique <150 pmol\/L + acide m\u00e9thylmalonique et homocyst\u00e9ine \u00e9lev\u00e9s (marqueurs fonctionnels plus sensibles) ; folates \u00e9rythrocytaires ; anti-facteur intrins\u00e8que (maladie de Biermer \u2014 50\u201370 % de sensibilit\u00e9) ; anti-cellules pari\u00e9tales (70\u201390 % mais peu sp\u00e9cifiques) ; traitement : B12 IM (cyanocobalamine ou hydroxocobalamine) si maladie de Biermer ou malabsorption ; B12 orale 1 000 \u00b5g\/jour si d\u00e9ficit alimentaire<\/td>\n <\/tr>\n <tr>\n <td>Thalass\u00e9mie (formes s\u00e9v\u00e8res)<\/td>\n <td>Pr\u00e9cipitation des cha\u00eenes \u03b1 exc\u00e9dentaires (\u03b2-thalass\u00e9mie) dans les \u00e9rythroblastes \u2192 \u00e9rythropo\u00ef\u00e8se inefficace s\u00e9v\u00e8re + po\u00efkilocytose marqu\u00e9e incluant dacryocytes, cellules cibles, ovalocytes, fragments ; \u03b2-thalass\u00e9mie majeure (Cooley) et \u03b2-thalass\u00e9mie interm\u00e9diaire ; h\u00e9molyse + spl\u00e9nom\u00e9galie + h\u00e9mosid\u00e9rose<\/td>\n <td>NFS : an\u00e9mie microcytaire hypochrome s\u00e9v\u00e8re ; frottis : po\u00efkilocytose majeure (dacryocytes + cellules cibles + ovalocytes + ponctuations basophiles) ; \u00e9lectrophor\u00e8se de l'h\u00e9moglobine (HbF \u00e9lev\u00e9e, HbA absente dans la thalass\u00e9mie majeure) ; ferritine \u00e9lev\u00e9e (h\u00e9molyse + surcharge en fer) ; g\u00e9notypage des g\u00e8nes de globine<\/td>\n <\/tr>\n <tr>\n <td>Causes rares et art\u00e9facts<\/td>\n <td>My\u00e9lofibrose r\u00e9actionnelle secondaire (tuberculose miliaire, histoplasmose, leishmaniose visc\u00e9rale \u2014 Kala-azar) ; h\u00e9moglobine C (dr\u00e9panocytose) ; d\u00e9ficit en pyruvate kinase ; spl\u00e9nectomie (dacryocytes transitoires post-spl\u00e9nectomie) ; art\u00e9fact de frottis (pseudo-dacryocytes orient\u00e9s dans la m\u00eame direction \u2014 cellules en larme de queue de frottis)<\/td>\n <td>Contexte clinique + s\u00e9rologies infectieuses si my\u00e9lofibrose r\u00e9actionnelle suspect\u00e9e ; examen soigneux du frottis (orientation des pointes \u2014 si toutes pointent dans la m\u00eame direction \u2192 art\u00e9fact) ; \u00e9lectrophor\u00e8se de l'h\u00e9moglobine + dosage enzymatique si h\u00e9molyse non expliqu\u00e9e<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Conduite \u00e0 tenir devant des dacryocytes au frottis<\/h2>\n <ul class=\"co-list\">\n <li>Premi\u00e8re \u00e9tape \u2014 confirmer et quantifier : s'assurer que les dacryocytes sont vrais (pointes orient\u00e9es dans plusieurs directions, aspect morphologique typique) et non des art\u00e9facts de queue de frottis (pseudo-dacryocytes orient\u00e9s uniform\u00e9ment) ; noter la pr\u00e9sence et la quantit\u00e9 d'\u00e9rythroblastes circulants (cellules nucl\u00e9\u00e9es \u2014 anormales en dehors de la grossesse et de l'hypoxie s\u00e9v\u00e8re), de formes jeunes granulocytaires (my\u00e9locytes, m\u00e9tamy\u00e9locytes \u2014 tableau leuco\u00e9rythroblastique), de plaquettes g\u00e9antes ou en amas<\/li>\n <li>Deuxi\u00e8me \u00e9tape \u2014 bilan biologique de premi\u00e8re ligne : NFS compl\u00e8te avec diff\u00e9rentiel manuel + r\u00e9ticulocytes ; LDH et acide urique (lyse tumorale et cellulaire) ; bilan h\u00e9patique complet (h\u00e9patom\u00e9galie sur \u00e9rythropo\u00ef\u00e8se extram\u00e9dullaire) ; ferritine (souvent tr\u00e8s \u00e9lev\u00e9e dans la MFP \u2014 marqueur inflammatoire + surcharge en fer) ; vitamine B12 et folates (\u00e9liminer la m\u00e9galoblastose) ; frottis r\u00e9examin\u00e9 par h\u00e9matologue<\/li>\n <li>Troisi\u00e8me \u00e9tape \u2014 imagerie et investigation sp\u00e9cialis\u00e9e : \u00e9chographie abdominale (spl\u00e9nom\u00e9galie \u2014 taille, volume en cm\u00b3) ou TDM abdomino-pelvien ; panel de mutations JAK2 V617F + CALR exon 9 + MPL W515 (NMP) sur sang p\u00e9riph\u00e9rique ; bilan d'extension oncologique si cancer primitif suspect\u00e9 (TDM + TEP-FDG + marqueurs tumoraux) ; orientation vers l'h\u00e9matologue pour biopsie ost\u00e9om\u00e9dullaire (BOM) \u2014 gold standard pour le diagnostic de my\u00e9lofibrose et d'envahissement m\u00e9dullaire<\/li>\n <li>Biopsie ost\u00e9om\u00e9dullaire (BOM) : r\u00e9alis\u00e9e sous anesth\u00e9sie locale \u00e0 la cr\u00eate iliaque post\u00e9ro-sup\u00e9rieure ; fournit : histologie (fibrose r\u00e9ticulinique et collag\u00e9nique \u2014 classification OMS MF-0 \u00e0 MF-3), cellularit\u00e9 m\u00e9dullaire, immunohistochimie (caract\u00e9risation des cellules tumorales m\u00e9tastatiques), cytog\u00e9n\u00e9tique (del(13q), del(20q), +8, +9 \u2014 anomalies fr\u00e9quentes dans les NMP) ; la my\u00e9lofibrose s\u00e9v\u00e8re rend souvent la biopsie aspirative (ponction-aspiration m\u00e9dullaire \u2014 PAM) impossible (moelle s\u00e8che \u2014 dry tap \u2014 pathognomonique de my\u00e9lofibrose avanc\u00e9e)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>La d\u00e9couverte de dacryocytes sur un frottis sanguin doit syst\u00e9matiquement conduire \u00e0 rechercher une <strong>leuco\u00e9rythroblastose<\/strong> (simultaneous presence of erythroblasts + immature granulocyte precursors in peripheral blood). This association\u2014 <strong>tableau my\u00e9lo-phtisique<\/strong> \u2014 indicates a profound disruption of bone marrow architecture and must lead to urgent hematological investigation (JAK2\/CALR\/MPL mutations + bone marrow biopsy) to primarily rule out primary myelofibrosis or metastatic bone marrow infiltration. The isolated presence of 1-2 dacryocytes without leucoerythroblastosis or splenomegaly can sometimes be observed in benign anemias \u2014 their clinical significance is then less but always to be considered in the clinical context.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Signes n\u00e9cessitant une consultation h\u00e9matologique urgente<\/div>\n <p>Consultez sans d\u00e9lai un m\u00e9decin ou un h\u00e9matologue si le frottis sanguin r\u00e9v\u00e8le des dacryocytes nombreux (2+ ou plus) associ\u00e9s \u00e0 : des \u00e9rythroblastes circulants, des granulocytes immatures (leuco\u00e9rythroblastose) ; une spl\u00e9nom\u00e9galie significative \u00e0 l'examen clinique ou \u00e0 l'imagerie ; une pancytop\u00e9nie ou une cytop\u00e9nie inexpliqu\u00e9e ; des sympt\u00f4mes constitutionnels (fi\u00e8vre prolong\u00e9e, sueurs nocturnes abondantes, amaigrissement inexpliqu\u00e9 >10 % en 6 mois) ; une LDH tr\u00e8s \u00e9lev\u00e9e sans cause \u00e9vidente.<\/p>\n <p>Ces \u00e9l\u00e9ments combin\u00e9s constituent un tableau my\u00e9lo-phtisique qui justifie une biopsie ost\u00e9om\u00e9dullaire en urgence relative (dans les 1 \u00e0 4 semaines) pour \u00e9liminer une my\u00e9lofibrose primaire \u00e9volutive ou un envahissement m\u00e9dullaire n\u00e9oplasique.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron interpr\u00e8tent les r\u00e9sultats de frottis sanguin, prescrivent le bilan de premi\u00e8re ligne devant la d\u00e9couverte de dacryocytes (NFS, LDH, ferritine, mutations JAK2\/CALR\/MPL, bilan oncologique si indiqu\u00e9) et orientent vers l'h\u00e9matologue pour biopsie ost\u00e9om\u00e9dullaire selon le tableau clinique. Des consultations sont disponibles dans nos points de service au Qu\u00e9bec ainsi qu'en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un professionnel de sant\u00e9 qualifi\u00e9. La pr\u00e9sence de dacryocytes sur un frottis sanguin doit toujours \u00eatre corr\u00e9l\u00e9e au contexte clinique et interpr\u00e9t\u00e9e par un m\u00e9decin.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron H\u00e9matologie & M\u00e9decine interne Dacryocytes (cellules en larme) Les dacryocytes \u2014 du grec dakryon (larme) \u2014 sont des globules rouges anormalement d\u00e9form\u00e9s pr\u00e9sentant une elongation unipolaire caract\u00e9ristique en forme de larme ou de goutte, avec une extr\u00e9mit\u00e9 arrondie et une extr\u00e9mit\u00e9 effil\u00e9e pointue. Ils… <a href=\"https:\/\/cliniqueomicron.ca\/en\/dacryocytes-cellules-en-larme\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Dacryocytes (Tear-shaped cells): Meaning and Causes | Omicron Clinic<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron","_metasync_otto_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Dacryocytes (cellules en larme) : | Brossard | Clinique Omicron","_metasync_otto_og_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","_metasync_otto_twitter_title":"Dacryocytes (cellules en larme) : | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Dacryocytes (cellules en larme) : signification et causes | Clinique Omicron","_aioseo_description":"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. Causes, diagnostic et prise en charge au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-21T14:53:24+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24490","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Les dacryocytes sont des globules rouges d\u00e9form\u00e9s en forme de larme, \u00e9vocateurs de my\u00e9lofibrose ou d'infiltration m\u00e9dullaire. 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