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Bone marrow findings in connective tissue disease.
1Institute of Pathology, Case Western Reserve University, Cleveland, Ohio 44106.
American Journal of Clinical Pathology
|November 1, 1989
Summary
Bone marrow biopsies in connective tissue diseases reveal diverse cellular abnormalities. Findings often explain cytopenias but can be unpredictable, highlighting the need for thorough evaluation.
Area of Science:
- Rheumatology
- Hematology
- Pathology
Background:
- Connective tissue diseases (CTDs) encompass a range of autoimmune disorders.
- Patients with CTDs often present with cytopenias and constitutional symptoms.
- Bone marrow examination is crucial for diagnosing and managing these complex conditions.
Purpose of the Study:
- To investigate the spectrum of bone marrow findings in patients with various CTDs.
- To correlate bone marrow abnormalities with clinical presentations such as cytopenias, fever, and suspected malignancy.
- To assess the utility of bone marrow biopsy in understanding the pathogenesis of hematological abnormalities in CTDs.
Main Methods:
- Analysis of 35 bone marrow biopsies from 32 patients diagnosed with rheumatoid arthritis, systemic lupus erythematosus, mixed connective tissue disease, polymyositis, or psoriatic arthritis.
- Reasons for biopsy included cytopenia, fever of unknown origin, and suspicion of malignancy.
- Histopathological examination, including immunoperoxidase staining, was performed to assess cellularity, plasma cell infiltration, lymphoid aggregates, and precursor cell morphology.
Main Results:
- Seventy-one percent of biopsies showed abnormal cellularity.
- Increased plasma cells (60%) and lymphoid aggregates were common, with polyclonal perivascular plasma cells and increased T-cells noted.
- Diverse findings related to anemia, variable iron stores, altered platelet and granulocyte precursors, myelodysplastic syndromes (in two RA patients), osteomalacia, and osteoporosis were observed.
Conclusions:
- Bone marrow findings in CTDs are highly variable and often multifactorial.
- Abnormalities can range from reactive changes to specific hematological conditions like myelodysplastic syndromes.
- Bone marrow biopsy provides valuable insights into the diverse causes of cytopenias and other complications in patients with connective tissue diseases.