Spectrum of Bone Marrow Morphologic Findings in Hepatitis C Patients with and without Prior Liver Transplantation
Jamie Boone, Wei Cui. University of Kansas Medical Center, Kansas City, KS
Background: Cytopenia is a common hematologic finding in patients with hepatitis C infection. Only one study has addressed bone marrow morphologic findings in these patients. No systemic study has been performed on hepatitis C patients with liver transplantation. Therefore, we examined bone marrow aspirate and biopsy specimens in 45 hepatitis C patients with and without prior liver transplantation.
Design: We retrospectively identified and studied 45 cases of serology proven hepatitis C patients with bone marrow biopsy from 2001 to 2012 at our medical center. We correlated the bone marrow findings with clinical findings.
Results: Nineteen cases of hepatitis C with transplantation and 26 cases of hepatitis C without transplantation were included. Among the patients with available complete blood count (n=41), the majority of the patients presented with cytopenia involving one or multiple cell linages including anemia (68%, n=28), neutropenia (59%, n=24), thrombocytopenia (70%, n=29) and pancytopenia (49%, n=17). Examination of the bone marrow revealed a wide spectrum of morphologic findings ranging from benign reactive processes including reactive lymphocytosis (n=6) and/or benign lymphoid proliferation (n=11), reactive plasmacytosis (n=9), aplastic anemia (n=2), and anemia of chronic disease (n=3) to overt malignant process including acute myeloid leukemia (AML, n=5), myelodysplastic syndrome (MDS, n=1) and T-lymphoblastic leukemia/lymphoma (n=1). Trilineage dysplasia was identified in 3 patients including 2 cases of AML and 1 case of MDS. Dysmegakaryopoiesis and dyserythropoiesis were identified in an additional 4 and 3 patients, respectively, including one patient with AML. The severity of neutropenia, thrombocytopenia and anemia was not correlated with the presence of cirrhosis or history of prior liver transplantation. However, the severity of thrombocytopenia and anemia was correlated with presence of splenomegaly (p < 0.05).
Conclusions: Cytopenia involving one or multiple cell lineages is a common finding in patients infected with hepatitis C virus, which occurs in 90% of our patients. Hypersplenism is only one of the contributing factors. The severity of neutropenia, thrombocytopenia and anemia is independent of cirrhosis or prior liver transplantation. Lastly, hepatitis C patients present with a wide spectrum of bone marrow findings including malignant myeloid neoplasms, which underscores the importance of routine bone marrow examination in these patients.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 187, Tuesday Morning