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The story of a starved bone marrow
* For correspondence: doctusharsehgal@yahoo.co.in
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Received: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 32 yr old male† came to the surgery outpatient department of Jaypee Hospital, Noida, India, in October 2019, for restoration of bowel continuity after resected small bowel gangrene. He was cachexic [body mass index (BMI) of 14.2 kg/m2]. Per abdomen was soft, non-tender with a functional stoma. Haemoglobin was 6 g/dl, WBC 3640/μl and platelet count was 12,000/μl. Total protein was 5.6 /dl, with albumin of 2.2 g/dl. Due to pancytopaenia, his surgery was deferred and was referred to haematology for advice. Bone marrow biopsy was performed and it was hypocellular with deposition of an eosinophilic material consistent with gelatinous marrow transformation (GMT) (Figs 1-3). GMT is a rare cause of pancytopenia. Common causes include anorexia nervosa and cachexia due to chronic debilitating illnesses such as AIDS, carcinoma, lymphoma, tuberculosis or other chronic infections. Differential diagnosis is important for GMT with other conditions, namely bone marrow oedema, bone marrow necrosis, aplastic anaemia and amyloidosis. In our case, GMT was due to malnutrition, and the patient was given a high-calorie diet with a good outcome. BMI at discharge was 19.4 kg/m2. He was successfully operated on after a week and was doing well after six months of follow up. Physicians should be aware of this uncommon cause of pancytopenia for adequate evaluation and prompt treatment of patients.
- Low-power view of the bone marrow biopsy showing hypocellular marrow spaces with the presence of extensive deposition of pale eosinophilic material (right arrow) between the adipose tissue (left arrow) and adjacent bone trabeculae (four-point star). The normal haematopoietic lineage elements are markedly reduced (H and E stain ×100).
- High-power view of the bone marrow biopsy highlighting the pale metachromatic eosinophilic material (arrows) (H and E stain ×600).
- The pale eosinophilic material showing bright blue positivity (red arrows) with Alcian blue at pH 2.5 (Alcian blue ×1000)
Acknowledgment
Authors acknowledge Dr R. Kapoor, Department of Gastrointestinal Surgery, Jaypee Hospital, Noida, for referring patient.
Conflicts of Interest: None.
