Bone marrow necrosis

Frequently unrecognized finding in routine bone marrow biopsies.

Incidence of bone marrow necrosis ranges from 0.5 percent to approximately one-third of all bone marrow biopsies examined.

The presence of bone marrow necrosis depends on the clinical condition of the patient.

In a study of bone marrow examinations the incidence of bone marrow necrosis was 37 percent of the bone marrow biopsies examined, and 26.4 percent of cases it was was mild. 7.5 percent moderate, and 3.1 percent had severe necrosis (Maisel D).

Most cases had an identifiable etiology such as a malignancy, or vascular or cytotoxic damage, with a small percentage being unexplained.

May be seen with sickle cell diseases, AIDS, leukemia, lymphoma, metastatic carcinoma, anemia, sepsis, and other systemic diseases.

Young and older patients usually demonstrate only small foci of necrosis.

Moderate and severe bone marrow necrosis are often associated with life threatening illnesses, with most of these being hematologic malignancies or bone marrow metastases.

In a study of 240 cases of extensive bone marrow necrosis 75% of patients had bone pain, and 68.5% had fever, 91% of cases associated with anemia, 78% had thrombocytopenia, and 51% have leukoerythroblastic changes, 50% of patients had elevated LDH and alkaline phosphatase levels (Janssens AM).

In the Janssenss’ study 90% of cases associated with a malignancy.

Caused by hypoxemia from failure of the microcirculation.

Pancytopenia and emboli are major complications.

Prognosis dependent on the underlying primary clinical condition.

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