Transcription of HYPOCELLULAR BONE MARROW… WHAT’S NEXT?
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HYPOCELLULAR BONE MARROW… WHAT’S NEXT?
HYPOCELLULAR BONE S NEXT? Assistant Professor of Pathology, University of Utah School of MedicineMedical Director, ARUP LaboratoriesAnton V Rets, , K/uLRBC M/uLHGB g/dLPLAT 21 K/uLWBC differentialNeutrophils2%Lymphocytes97%M onocytes1%2 26-year-old male presents with septic shockLet s start with a case3 Flow cytometry: unremarkable Karyotype: no metaphase cellsDIAGNOSIS:Markedly HYPOCELLULAR marrow with no morphologic or flow cytometric evidence of malignancyIs there anything else to be done?4 Ancillary studies Bone marrow failure (BMF) sustained inability of the bone marrow to produce adequate numbers of blood forming elements Unilineageaplasia (red cell aplasia, neutropenia, thrombocytopenia) Trilineage aplasia = aplastic anemia Aplastic anemia (AA) multiple cytopenias with TRILINEAGE bone marrow failure in absence of secondary bone marrow replacement process (neoplasia, reticulin fibrosis, etc.) Constitutional (constitutional BMF) Acquired AA Secondary Idiopathic separate entity5 DefinitionsStratification by severityVery severeANC of K/uLSevereANC of K/uLNon-severeANC of > K/uLStrong predictor of survival6 All three criteria must be least two of the ANC < PLAT <20 reticulocyte count <20 marrow hypoplasia -<25% of normal age-appropriate cellularity, hypoplasia (25-50% of normal age-appropriate cellularity with <30% cells being hematopoietic) of overt malignancy, fibrosis, or abnor
rheumatoid arthritis •Currently on Abatacept •Evaluated for persistent neutropenia Case. 11. 12 •Flow cytometry ... •Pathogenesis differs from non-h-MDS –significant immune/autoimmune dysregulation similar to i-AA •Other diagnostic criteria are the same as for non-h-MDS 22
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