Reversal of bone marrow hypoplasia in anorexia nervosa: Case report

Orlandi, Emanuele; Boselli, Paolo; Covezzi, R.; Bonaccorsi, Goretta; Guaraldi, Giovanni

doi:10.1002/(sici)1098-108x(200005)27:4<480::aid-eat14>3.0.co;2-3

Cited by 16 publications

(8 citation statements)

References 14 publications

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“…In humans, diffuse change in the MR signal intensity of trabecular bone has been recognized in emaciated patients suffering from psychogenic eating disorders 7–9,31,32 . In the head, the progressive loss of fat occurs from the bone marrow, the subcutaneous tissue, and then the orbits 8 .…”

Section: Discussionmentioning

confidence: 99%

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Magnetic Resonance Imaging Features of Serous Atrophy of Bone Marrow Fat in the Distal Limb of Three Horses

Sherlock¹,

Mair²,

Murray³

et al. 2010

Veterinary Radiology &Amp; Ultrasound

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Emaciated human patients have changes in the fat content in medullary bone that are consistent with serous atrophy of the bone marrow histologically. Serous atrophy has been identified at postmortem examination in horses; however, the magnetic resonance (MR) characteristics have not been documented. Herein we describe the abnormalities of the bone marrow and medullary bone detected by low-field and high-field MR imaging of the distal limbs of three emaciated horses. These low- and high-field MR imaging abnormalities are characterized by a decrease in signal intensity on T1-weighted images in combination with an increase in signal intensity on short tau inversion recovery images in all areas of trabecular bone in the distal limbs, in the absence of lameness. Serous atrophy was confirmed microscopically in two horses. Appreciating the sensitivity of MR imaging for detection of bone marrow changes may assist in assessment of fat atrophy in welfare cases where starvation is suspected.

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Section: Discussionmentioning

confidence: 99%

“…Emaciated human patients have altered medullary bone signal due to serous atrophy of the bone marrow 5–9 . Although serous atrophy occurs in horses, 10 there are no descriptions of the MR characteristics of this abnormality.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging Features of Serous Atrophy of Bone Marrow Fat in the Distal Limb of Three Horses

Sherlock¹,

Mair²,

Murray³

et al. 2010

Veterinary Radiology &Amp; Ultrasound

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“…Reversal of hematopoietic atrophy in anorexic humans occurs within 14 to 25 days after institution of proper nutrition. 3,10,22 Similarly, in this case, anemia and leukopenia resolved within approximately 3 weeks of correction of starvation (Table 1). In the diagnostic investigation of serous atrophy of fat, routine fixation may not be ideal for the identification of an extracellular matrix rich in hyaluronic acid, which is best preserved for optimal staining by fixation in 10% acid formalin with 70% ethanol rather than in 10% neutral-buffered formalin.…”

Section: Discussionmentioning

confidence: 53%

Gelatinous Marrow Transformation and Hematopoietic Atrophy in a Miniature Horse Stallion

et al. 2010

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Gelatinous marrow transformation, or serous atrophy of bone marrow fat, has been noted in livestock, laboratory animals, and wildlife in association with an inadequate plane of nutrition, inanition, or intoxication. This is a report of gelatinous marrow transformation and hematopoietic marrow atrophy in a 5-year-old miniature horse stallion. The horse had oral malformations leading to poor food assimilation and emaciation. A bone marrow biopsy obtained to investigate persistent anemia and leukopenia showed hematopoietic atrophy and replacement of fat with a granular extracellular substance, which stained with alcian blue, consistent with acidic mucopolysaccharide content. Surgical correction of the dental abnormalities resulted in improved food assimilation, weight gain, and resolution of cytopenias. In humans, gelatinous bone marrow transformation and hematopoietic atrophy are commonly associated with malnutrition from anorexia nervosa and other causes. The cause of hematopoietic atrophy is unknown but may relate to a nonsupportive marrow microenvironment and inadequate hematopoietic substrate availability. Similar pathogenic mechanisms were suspected in this horse.

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“…We conducted a Medline review of 134 cases of AN associated with GMT published in English literature from 1974 to 2009. Only two cases were treated with hematopoietic growth factors; one with recombinant human G‐CSF5 and one with recombinant human Erythropoietin 6. We report the first ever case using a combination of these growth factors resulting in a rapid and sustained hematopoietic recovery.…”

Section: Discussionmentioning

confidence: 97%

Successful management of gelatinous transformation of the bone marrow in anorexia nervosa with hematopoietic growth factors

Charania

Kern

Charkrabarty

et al. 2011

Intl J Eating Disorders

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Serous atrophy or gelatinous transformation of the bone marrow (GMT), often seen with severe nutritional deprivation in Anorexia Nervosa (AN), is characterized by hypocellularity and patchy or diffuse replacement of the bone marrow with hyaluronic acid-like mucopolysaccharide material. Treatment with nutritional support alone is often temporary due to the relapsing nature of AN. We present the case of a patient with pancytopenia due to GMT who had multiple prior hospitalizations for infections and blood transfusions. Nutritional support was inadequate in restoring her bone marrow function. She was successfully treated with hematopoietic growth factors and achieved a sustained hematopoietic recovery. In addition, use of growth factors resulted in a 91% reduction in the cost of health care delivered to this patient.

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Reversal of bone marrow hypoplasia in anorexia nervosa: Case report

Cited by 16 publications

References 14 publications

Magnetic Resonance Imaging Features of Serous Atrophy of Bone Marrow Fat in the Distal Limb of Three Horses

Magnetic Resonance Imaging Features of Serous Atrophy of Bone Marrow Fat in the Distal Limb of Three Horses

Gelatinous Marrow Transformation and Hematopoietic Atrophy in a Miniature Horse Stallion

Successful management of gelatinous transformation of the bone marrow in anorexia nervosa with hematopoietic growth factors

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