Gelatinous Transformation of Bone Marrow: A Prospective Tertiary Center Study, Indicating Varying Trends in Epidemiology and Pathogenesis

Abstract

Gelatinous bone marrow transformation (GTBM) also known as serous atrophy is a degenerative change in the hematopoietic bone marrow and is a rare well recognized pathological entity. It was earlier described mainly in association with anorexia nervosa and psychiatric eating disorders, but recently it has been reported in ulcerative colitis, tuberculosis, chronic renal diseases, immuno suppressed states (mainly HIV infection), malignancies and Kala azar. Treatment is based on treating the underlying disease. Our objective was to study the epidemiology and pathogenesis of diseases causing gelatinous transformation of bone marrow, at a tertiary center level. A prospective study was conducted on 732 samples of bone marrow aspirate with the aim of identifying gelatinous transformation in bone marrow aspirates which was confirmed by Alcian blue stain at pH 2.5. The presence of this material was correlated with the hematological profile of the patient, the presenting signs and symptoms and provisional clinical diagnosis at initial visit. Incidence of gelatinous transformation was calculated to be nearly 4.8 % and the condition was more common in males (23) as compared to females (12) (Male:Female = 2:1). Forty percent of the cases were seen in children followed by 37 % in adolescents and young adults. The older individuals comprised only 23 % of the cases. The bone marrow was hypocellular in 21 (60 %), normocellular in 10 (28.5 %) and hypercellular in four cases (11.5 %). Five cases with GTBM progressed to aplastic anaemia of which three were in children.

Gelatinous transformation of bone marrow: rare or underdiagnosed?

“… 3 , 63 Histological examination was characterized by different patterns of bone marrow cellularity, varying from hypocellularity to normocellularity—or even cases of hypercellularity with focal areas of hypocellularity surrounding the gelatinous deposits. 31 , 63 , 65 , 66 Böhm 3 graded the bone marrows from 1 to 4 based on the severity of gelatinous transformation.…”

“…Pearson 5 and Tavassoli et al 6 firstly reported the reversibility of GTBM on animal experiments. In our review, we found 35 cases that showed the disappearance of the GTBM on follow-up on repeated biopsy/aspirate after the initiation of treatment, which was either in the form of nutritional diet (15 cases), 58 , 60 , 62 , 66 packed red blood cell (PRBCs) transfusion (one case), 57 granulocyte colony stimulating factor (G-CSFs) (three cases) 51 or treatment of the underlying disease.…”

“…The reported incidence of GTBM varies from 0.2%, 3 to 4.4% 37 and 4.8%. 66 This rising trend in its incidence over the years indicates that GTBM, in the current scenario, is anything but rare. On review of the literature, Seaman et al 2 seems to aptly describe GTBM as “Not uncommon,” whereas the majority of studies continue to report it as “a rare condition.” Based on our analysis, we conclude that the low incidence observed in the 20th century can be ascribed to the lack of awareness about the existence of such an entity.…”

Gelatinous Transformation of Bone Marrow in a Patient with Anorexia Nervosa: An Uncommon but Reversible Etiology

“…The reported frequency of gelatinous transformation of bone marrow varies from 0.2% to 4.8% [ 8 , 9 ]. The increased number of case reports published in the last 2 decades point to the possibility of under diagnosis or missed diagnosis [ 8 ].…”

“…The increased number of case reports published in the last 2 decades point to the possibility of under diagnosis or missed diagnosis [ 8 ]. It is usually observed in young males [ 9 ]. Diagnosis can be suspected on the basis of peripheral blood count with the common presentation being bicytopenia or pancytopenia.…”