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

Charania, Roseleen; Kern, William; Charkrabarty, Shouvik; Holter, Jennifer

doi:10.1002/eat.20833

Cited by 22 publications

(22 citation statements)

References 7 publications

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“…17 Furthermore, recent studies, also conducted by our group, identified PA as a prognostic predictor of survival in cancer malnutrition. 18, 19, 20 Interestingly, other studies on hematological disorders in AN in smaller samples of patients from Northern Europe countries 21, 22, 23, 24 and United States 25 showed an increased prevalence of anemia, leukopenia and thrombocytopenia. In particular, Lambert et al , 24 despite the small sample size (10 patients with AN), showed a correlation between total body fat mass and bone marrow depletion (serous bone marrow atrophy) evaluated by magnetic resonance imaging and peripheral blood parameters (lower erythrocyte, leukocyte, neutrophil and platelet counts).…”

Section: Discussionmentioning

confidence: 95%

Hematological complications in anorexia nervosa

et al. 2016

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Background/objectives:Anemia, leukopenia and, although less frequently, thrombocytopenia are possible hematological complications of anorexia nervosa considered strictly secondary to chronic malnutrition. This is a retrospective study on the prevalence of these disorders in a large cohort of 318 female patients with AN (20.4±5.6 years, body mass index (BMI) 15.9±1.6 kg/m2), recruited in the Outpatient Unit for Malnutrition secondary to Eating Disorders at the Department of Clinical Medicine and Surgery, Federico II University Hospital, since February 1991 to December 2012.Subjects/methods:Patients were studied on an outpatient basis after obtaining medical history, clinical examination, routine hematobiochemical and endocrine tests, electrocardiography, psychiatric interview and bioelectrical impedance analysis and, in particular, phase angle determination. All patients with other comorbidities, in particular with mean corpuscular volume <80 fl, were excluded for suspected genetic alteration in the synthesis of hemoglobin.Results:Hematologic data showed that 16.7% of patients had anemia, 7.9% neutropenia and 8.9% thrombocytopenia. These abnormalities were strictly related to the duration of illness (P=0.028), and to protein energy malnutrition, in particular, BMI and phase angle (P<0.001).Conclusions:Our study offers description of the incidence of hematologic defects in a selected and large sample of AN female patients, suggesting that its incidence is related to the degree and duration of protein energy malnutrition.

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Section: Discussionmentioning

confidence: 95%

Hematological complications in anorexia nervosa

et al. 2016

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Gelatinous transformation of bone marrow: rare or underdiagnosed?

Shergill¹,

Shergill²,

Pillai³

2017

Autops. Case Rep.

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Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus, HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility—notably in cases of malnutrition and anorexia—this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis.

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“…The nutritional support was sufficient, and the improvement of patient's health condition was reversible with appropriate food intake. 15 However, careful follow-up is necessary because the natural history of AN includes frequent relapse, 4 and AN will often require psychiatric treatment, especially when it is recalcitrant.…”

Section: Discussionmentioning

confidence: 99%

Gelatinous Transformation of Bone Marrow in the Calcaneus, Diagnosed by Open Bone Biopsy in a Patient With Anorexia Nervosa

Tonogai

Nakajima

Miyagi

et al. 2018

Foot & Ankle Orthopaedics

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Gelatinous transformation of bone marrow (GTBM) is a complication of various diseases, one of which is anorexia nervosa (AN). We describe a rare case of a 20-year-old man who presented to our clinic with a 3-month history of heel pain without trauma. At presentation, he was noted to have a low body mass index (BMI) of 16.2 kg/m 2 and pancytopenia. On magnetic resonance imaging, the left calcaneus showed low intensity on T1-weighted and high intensity on T2-weighted images. Open biopsy was done because we suspected that the lesion was either a lymphoproliferative tumor or a trabecular-type bone metastatic tumor. However, tissue histology of bone samples showed atrophy of fat cells with deposition of gelatinous material and a decreased hematopoietic cell population. Therefore, we made a diagnosis of GTBM, most likely caused by AN. We started treatment with nutritional support, and 6 months later, the hematological parameters returned to normal and BMI improved to 19.4 kg/m 2. He was able to return to work and had no left heel pain. This case indicates that foot and ankle surgeons need to be aware of this rare pathology, although it might be difficult to diagnose without biopsy. To our knowledge, very few descriptions of GTBM in the calcaneus have been reported to date.

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

Cited by 22 publications

References 7 publications

Hematological complications in anorexia nervosa

Hematological complications in anorexia nervosa

Gelatinous transformation of bone marrow: rare or underdiagnosed?

Gelatinous Transformation of Bone Marrow in the Calcaneus, Diagnosed by Open Bone Biopsy in a Patient With Anorexia Nervosa

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