Gelatinous transformation of the bone marrow from anorexia nervosa

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Gelatinous transformation of the bone marrow from anorexia nervosa
From www.bloodjournal.org by guest on August 11, 2017. For personal use only.
bloodwork
®
IMAGES
IN HEMATOLOGY
Gelatinous transformation of the bone
marrow from anorexia nervosa
c Kristian T. Schafernak, Phoenix Children’s Hospital
A
16-year-old girl with X-linked hypophosphatemic rickets, anorexia nervosa, and rumination syndrome with severe
malnutrition underwent bone marrow examination for leukopenia (2.03 3 109/L), mildly macrocytic anemia (hemoglobin,
106 g/L; mean corpuscular volume, 99.3 fL), and thrombocytopenia (114 3 109/L), which had persisted during refeeding.
The bone marrow aspirate smears (panel A; Wright-Giemsa stain) contained stromal elements (amorphous bluish-pink material,
capillaries, and nuclei) and occasional hematopoietic cells, most of which were lymphocytes. The trephine biopsy (panel B;
hematoxylin and eosin stain) demonstrated a mix of amorphous bluish, finely fibrillar/granular material (in which focal adipocytic
atrophy was noted) consistent with gelatinous transformation and foci of multilineage hematopoiesis. Alcian blue (pH 2.5) and
Alcian blue-periodic acid-Schiff stains (panels C-D) revealed that the amorphous material was composed of acid mucosubstances.
Gelatinous transformation, also known as serous fat atrophy, is a relatively nonspecific bone marrow finding which has been linked
to anorexia nervosa (as in our patient) and cachexia from chronic debilitating illnesses such as infections (AIDS, tuberculosis,
leishmaniasis), malignancy (carcinoma, leukemia/lymphoma), lupus, hypothyroidism, renal or heart failure, celiac disease,
intestinal lymphangiectasia, and alcoholism and has been found at irradiated sites. Marrow and subcutaneous fat signal
abnormalities can also be detected with magnetic resonance imaging.
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DOI 10.1182/blood-2015-11-683946
1374
© 2016 by The American Society of Hematology
BLOOD, 10 MARCH 2016 x VOLUME 127, NUMBER 10
From www.bloodjournal.org by guest on August 11, 2017. For personal use only.
2016 127: 1374
doi:10.1182/blood-2015-11-683946
Gelatinous transformation of the bone marrow from anorexia nervosa
Kristian T. Schafernak
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