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4 - The aplasias

Published online by Cambridge University Press:  07 August 2009

Attilio Orazi ,
Dennis P. O'Malley  and
Daniel A. Arber
Attilio Orazi
Affiliation:
Indiana University
Dennis P. O'Malley
Affiliation:
Indiana University
Daniel A. Arber
Affiliation:
Stanford University, California
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Summary

Introduction

A decrease in bone marrow cellularity for a patient's age may be related to a variety of causes. Artifactual hypocellularity due to sampling of only subcortical marrow should not be misinterpreted, and an accurate estimate of marrow cellularity cannot be made on small biopsy specimens that contain only the subcortical marrow space. True hypocellularity may be due to a decrease in all marrow cell lines or decreases in only selected cell lines.

Aplastic anemia

Aplastic anemia (AA) may be acquired or constitutional (congenital), and represents a decrease in granulocytic, erythroid, and megakaryocytic cells (Guinan, 1997; Young, 1999). The principal conditions associated with the development of acquired and inherited aplastic anemia are summarized in Table 4.1.

Diagnostic criteria for severe aplastic anemia are (1) a bone marrow of less than 25% of normal age-related cellularity values, and (2) two of the following three peripheral blood findings: a neutrophil count of less than 0.5 × 109/L, a platelet count of less than 20 × 109/L, anemia with a corrected reticulocyte count of less than 1%. A grading system for AA patients is summarized in Table 4.2.

The peripheral blood demonstrates pancytopenia without obvious abnormalities of the circulating cells (Camitta et al., 1979). Aspirate smears usually show small particles containing histiocytes, mast cells, lymphocytes, and plasma cells with no or rare normal hematopoietic cells. The biopsy specimens in these patients are variably hypocellular (Fig. 4.1).

Type
Chapter
Information
Illustrated Pathology of the Bone Marrow , pp. 22 - 30
Publisher: Cambridge University Press
Print publication year: 2006

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