Bone Marrow Examination for Unexplained Cytopenias Reveals Nonspecific Findings in Patients With Collagen Vascular Disease

Abstract

Context.—Collagen vascular diseases are frequently included in the differential diagnosis for unexplained cytopenias and often prompt a bone marrow biopsy in this patient population to exclude malignancy. Few large-scale studies have characterized the bone marrow morphology in patients with collagen vascular disease, and most are limited to systemic lupus erythematosus or rheumatoid arthritis. Objective.—To identify morphologic and immunohistochemical abnormalities specific to each of a wide range of collagen vascular disease cases. Design.—We examined 102 cases of collagen vascular disease and 38 controls and evaluated the complete blood count, peripheral blood morphology, bone marrow morphology, as well as immunohistochemical staining, for numerous cell lineages. Results.—Bone marrow findings, including abnormalities such as lymphoid aggregates, lipogranulomas, or abnormal localization of immature precursors, were not significantly different as compared to the control group. Conclusions.—Bone marrow examination in patients with collagen vascular disease with cytopenias seldom provides new information. Caution should be exercised in interpreting morphologic findings suggestive of myelodysplasia since these are of a reactive nature in up to 27% of patients with collagen vascular disease. In a cost-effective diagnostic strategy, successful utilization may favor postponing a bone marrow biopsy while a more standardized autoimmune diagnostic panel is being performed.

Lymphoid aggregates in bone marrow: a diagnostic pitfall

“…In a large study on 108 bone marrow biopsies of patients with known autoimmune diseases, Hunt et al demonstrated the presence of LAs. LAs were more frequently seen in systemic lupus erythematous and rheumatoid arthritis, where they occurred in as many as 40% and 42% of cases, respectively 24. These results are in line with precedent studies 25 26.…”

A Close Association of Autoimmune-Mediated Processes and Autoimmune Disorders with Chronic Myelomonocytic Leukemia: Observation from a Single Institution

“…Further study is warranted to explore the underlying process from autoimmunity to gene dysregulation and to MDS/CMML manifestation, as well as to help an earlier diagnosis of the transition from the reactive process to clonal evolution. Similarly, it is not uncommon for patients with AID beyond ITP to have accompanied cytopenia and morphologic dysplasia, such as dyserythropoiesis and/or abnormal localization of immature precursors [30,31,32], and a subset of AIDs could eventually develop MDS [33]. Thus, a complete immunologic workup is necessary to exclude underlying AID before a diagnosis of MDS or CMML is rendered [32].…”

Long-term immunosuppression and multiple transplants predispose systemic lupus erythematosus patients with cytopenias to hematologic malignancies

“…[16] Subsequent reports have described hypocellularity, increased reticulin, myelofibrosis and necrosis, abnormal iron stores, and increased plasma cells among other abnormalities. [17][18][19][20][21][22][23] Dyserythropoiesis and hypoplasia have been found in the BM of 40% of the SLE patients, and gelatinous or serous transformation have been observed in fewer than 8% of the SLE patients. [24,25] Consistent with previous reports, we observed hypocellularity and myeloid hypoplasia in 57% of the patients with nonneoplastic BM, however, serous atrophy was found at a higher frequency (23 vs 8%) than that reported previously.…”

“…BM alterations in SLE have been the focus of a number of studies since the early 1950s when 32 of 111 SLE patients with hematological abnormalities underwent BM biopsy without revealing a plausible explanation for the observed cytopenias [16] . Subsequent reports have described hypocellularity, increased reticulin, myelofibrosis and necrosis, abnormal iron stores, and increased plasma cells among other abnormalities [17–23] . Dyserythropoiesis and hypoplasia have been found in the BM of 40% of the SLE patients, and gelatinous or serous transformation have been observed in fewer than 8% of the SLE patients [24,25] …”