Abstract
Abstract 4840
Patients with hepatitis C often present with cytopenias - thrombocytopenia, neutropenia and less commonly anemia. Hypersplenism may contribute to cytopenias but effects on the bone marrow due to the hepatitis C infection also likely play a role in its pathogenesis. Hepatitis C infection predisposes to development of lymphomas as well. The bone marrow findings in patients with hepatitis C infection are not well described and to our knowledge there has only been one peer reviewed study published till date.
In order to elucidate this further, we conducted a retrospective review of bone marrow biopsies performed at our institution on patients with known hepatitis C infection.
Between years 1999 and 2010, 56 adults (36 male and 20 female) patient with hepatitis C underwent bone marrow biopsies. The indications for bone marrow biopsy included evaluation or staging of lymphoma or myeloma (24 patients) OR investigation of cytopenias (32 patients). None of the patients were on treatment for Hepatitis C at the time of the bone marrow biopsy.
Of the 24 patients with lymphoma/myeloma, 11 showed bone marrow involvement, while 10 patients had benign lymphocyte aggregates in the marrow. 9 out of 24 patients had a hypercellular marrow and 8 had a hypocellular marrow. Mild to moderate megaloblastic change in the erythrocyte series was seen in 5 patients and dyserythropoiesis in 2. Hyperplasia of megakaryocytes was seen in 11/24 and 6/24 showed atypical megakaryocytes with focal clustering in 7/24. Reticulin fibrosis was noted in 7 patients. Iron stores were increased in 13/24 with decreased sideroblasts in 15/24 patients.
Review of the 32 patients who had the bone marrow biopsy done for cytopenias showed 16 were hypocellular and 9 were hypercellular while 4 patients had variable cellularity. Mild to moderate megaloblastic change in the erythrocyte series was seen in 12/32 and dyserythropoiesis in 11/32. Granulocytic hypoplasia was seen in 14/32. Benign lymphoid aggregates were noted in 20 patients. Hyperplasia in the megakaryocytes was seen in 8 while 11 had decreased megakaryocytes. Atypical megakaryocytes were noted in 10/32 with clustering seen in 4 patients. Reticulin fibrosis was noted in 13 patients. Iron stores were increased in 16/32 and sideroblasts were decreased in 13/32. Frank hemophagocytosis was observed in 5 patients. Of these 32 patients, 4 were HIV positive. Myelodysplastic syndrome was diagnosed in 2/32, AML and Hemophagocytic lymphohistiocytosis in one each.
Bone marrow biopsies are usually performed in patients with Hepatitis C to investigate cytopenias and for diagnosis or staging lymphoma or myeloma. Even without lymphoma involving the marrow, a substantial number of patients have benign lymphocyte infiltrates seen in the marrow. Marrow hypocellularity is common. Megaloblastic change in the erythroid series, dyserythropoiesis, atypical megakaryocytes and reticulin fibrosis can be seen in a substantial minority of the patients which contribute to cytopenias.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
