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The bone marrow in AIDS. A histologic, hematologic, and microbiologic study.

A Castella, T S Croxson, D Mildvan

    American Journal of Clinical Pathology
    |October 1, 1985
    PubMed
    Summary
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    Bone marrow analysis in patients with acquired immune deficiency syndrome (AIDS) revealed frequent plasma cell increases and anemia. Other findings like granulomas and lymphomas also suggest AIDS in high-risk individuals.

    Area of Science:

    • Hematology
    • Immunology
    • Infectious Diseases

    Background:

    • Acquired immune deficiency syndrome (AIDS) is a complex condition impacting multiple organ systems.
    • Bone marrow examination is crucial for diagnosing opportunistic infections and hematological abnormalities in AIDS patients.

    Purpose of the Study:

    • To investigate the spectrum of bone marrow findings in patients with acquired immune deficiency syndrome (AIDS).
    • To identify hematological and infectious markers in bone marrow biopsies that may suggest AIDS.

    Main Methods:

    • Analysis of 55 bone marrow biopsies from 49 patients diagnosed with acquired immune deficiency syndrome (AIDS).
    • Evaluation of cellularity, plasma cell counts, peripheral blood counts, iron studies, and presence of granulomas, lymphoplasmacytic aggregates, and lymphomas.

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    Main Results:

    • 83% of biopsies were normo- or hypercellular; 17% were hypocellular.
    • Increased marrow plasma cells (83%) with polyclonal hypergammaglobulinemia were common.
    • Anemia (85%) consistent with chronic disease, neutropenia (40%), thrombocytopenia (29%), and lymphopenia (79%) were prevalent.
    • Mycobacterium avium-intracellulare (MAI) was identified in 20% of biopsies.
    • Granulomas (16%) and lymphoplasmacytic aggregates (10%) were observed, with some cases progressing to lymphoma.

    Conclusions:

    • While marrow MAI is a definitive AIDS indicator, ill-defined granulomas, lymphoplasmacytic aggregates, and B-cell lymphomas in high-risk patients also strongly suggest AIDS.
    • These findings, especially with lymphopenia, anemia, or hypergammaglobulinemia, aid in diagnosing AIDS.
    • Bone marrow pathology provides valuable diagnostic clues for AIDS, extending beyond opportunistic infections.