Bone Marrow Biopsy in Patients with HCV: Spectrum of Findings and Diagnostic Utility
JM Klco, B Geng, M Lisker-Melman, EM Brunt, A Hassan, F Kreisel, JL Frater. Washington University School of Medicine, Saint Louis, MO
Background: Patients with hepatitis C (HCV) develop a number of hematologic disorders including cytopenias, which are felt to stem primarily from hypersplenism and/or antiviral medications. To date, no study has reported on the spectrum of bone marrow morphologic changes in patients with HCV.
Design: 49 adult patients (28 M, 21 F) with HCV without HIV coinfection that underwent a bone marrow biopsy were identified. The bone marrow findings, peripheral cell counts and features of chronic hepatitis, including cirrhosis, splenomegaly, treatment, and MELD score (a system for assessing the severity of chronic liver disease) are reported.
Results: 59% (23/39) of the patients presented with cirrhosis, either by radiographic studies or liver biopsy, 76% (29/38) with splenomegaly and 12% (6/49) had a history of antiviral treatment with interferon and ribavirin. The average MELD score was 9.5 (range 2.3-28.2, max. score 40). The patients typically presented with anemia (mean: 10.2 g/dl) and thrombocytopenia (mean: 135 109/L) with a normal WBC count (mean: 5.11 109/L). 36% (17/47) of patients presented with pancytopenia, which was the most frequent indication for bone marrow biopsy. The average marrow cellularity was 50%. Dyserythropoeisis was the most common finding on biopsy (39%, 19/49). 11 (22% of total) of those patients had dysplasia in one or more additional lineages. Other findings included AML (x2), hemophagocytosis (x1), plasma cell myeloma (x1) and polyclonal lymphocytosis (x7). The highest diagnostic yield of bone marrow abnormalities was in the pancytopenic patients with two patients with AML, 5 with multilineage dysplasia (MLD), and 5 with isolated dyserythropoeisis. The five patients with MLD had an average marrow cellularity of 66% with no ringed sideroblasts (n=2). There was no correlation in bone marrow findings and MELD score, stage of chronic hepatitis or splenomegaly.
Conclusions: 1. Patients with pancytopenia, even with clinical features of hypersplenism and/or documented antiviral medication warrant a bone marrow biopsy for hematologic evaluation. 2. Degree of bone marrow dysfunction is independent of stage of chronic hepatitis. 3. Hematologic malignancy is rare in this population yet there is a high percentage of morphologic abnormalities. 4. Exercise caution to avoid misdiagnosis of primary myelodysplasia.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 185, Monday Morning