Bone Marrow Findings in Veterans (V) with Hepatitis C Infection (HCV) at a VA Medical Center

Background: Hepatitis C Virus (HCV) is a major public health problem, with an increased prevalence in Veterans. HCV has been associated with B cell Lymphoproliferative disorders and Type II and III Cryoglobulinemias.Prior studies also found that patients with HCV are more likely to develop cytopenias compared normal. Little is known about other possible hematologic manifestations of HCV.We present a series of 54 Veterans seen in a hematology oncology clinic with HCV and their hematologic and bone marrow findings

Methods: In an IRB-approved protocol, we reviewed the records of V with HCV who underwent bone marrow biopsy from January 1993 to July 2015. V with hematological malignancies, coinfection with human immunodeficiency virus (HIV), hepatitis A or B, were excluded. Demographics, Vietnam era status, clinical and pathological data, indications for bone marrow biopsies, and results were abstracted. Statistical analysis was performed using SAS 9.4.

Results: Of the 54 V, 30 Caucasians, 22 African Americans and 2 Hispanics met the eligibility criteria. 37 served in the Vietnam era. The median (M) age was 59 years (range 39-90). M for WBC 6.9 x10⁹/L (2.9-36.3), hemoglobin 14.3 gm/dL (6.9-19), MCV 93.1 fL (68.8-110..6), platelets 172 x10⁹/L (39-493) , total bilirubin 0.75 mg/dl (0.1-5.3), alkaline phosphatase 96.5 U/L (56-341), albumin 3.9 g/dl (1.6-4.9), lactate dehydrogenase 191 IU/L (91-867), AST U/L (19-426), ALT 56.5.U/L (4-480), INR 1.09 (0.84-2.04). 12 V had splenomegaly by imaging. 10 V at the time of bone marrow biopsy had cirrhosis. The most common indication for bone marrow biopsy was cytopenia (n=38) in at least one of the lineages. The remaining (n=16) were for paraproteinemia, lytic lesion, leukocytosis or lymphocytosis. 48 V had abnormal bone marrow biopsy findings (summarized in Table 1) and 6 V had normal biopsy findings.

Conclusions: Veterans with HCV develop cytopenias and hematological malignancies. While Cytopenias can result from splenomegaly, autoimmune mechanism, and medications, some of the cytopenias are unexplained Bone marrow changes from chronic HCV infection may be a contributing factor. Understanding these bone marrow changes from HCV may help in determining the etiology and further management of hematological problems related to HCV