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Bone marrow biopsy in 30 years old female

Dr. Vijay Singh

Fiji School of Medicine

Fiji
Comentado en:
PATOLOGIA
PATOCITO
HEMATOLOGIA
FOROPAT
 Historia Clínica
Age:30 yrs
Race:Indian
Sex:Female

Clinical details:Presented 4 months back with fever, joint pains, and rash.History of mouth ulcers. Hb.- 8.7, MCV-97, Total white cell count-5,200, Platelet count- 60,000. ANA & dsDNA were negative. She was given prednisolone & azathioprine. She improved but only a little. She was then discharged. She then came back again with Hb.-6.5, Total white cell count-1,000, and platelet count of 133,000. ESR was 120. The serological tests were repeated (ANA & dsDNA) which were again negative.

Provisional Diagnosis:?Mixed connective tissue disorder, ?Hypo plastic bone marrow,?Infiltration of bone marrow Peripheral smear showed normocytic normochromic blood picture with occ. erythroid precursors.

The trephine biopsy & bone marrow aspirate were hyper cellular. We could not see any hypoplasia or tumor infiltration.

Imagen de Bone marrow biopsy in 30 years old female
Peripheral blood smear.
 Iconografía
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow trephine biopsy.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow trephine biopsy.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow trephine biopsy.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow trephine biopsy.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow trephine biopsy.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow aspirate.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow aspirate.
Imagen de Bone marrow biopsy in 30 years old female
Bone marrow aspirate.
 Comentarios

 

El 5/9/2004 22:51, Ricardo Drut dijo:

The figures (or the slides themselves) do not repreduce too well in this case, but No.2 seems to present foci of ALIP. Same does Fig.8. As a matter of fact there seems to be some hypocellularity in this bone marrow.

Flow cytometry and kariotyping looking for CML (t18;22) may be of some aid.

 

El 7/9/2004 16:44, Dan Pankowsky dijo:

I am worried about myelodysplasia but I agree, cannot rule out myeloproliferative disorder. All the other possibilities: infection, drug therapy, toxic exposure (lead?), should be considered. Autoimmune disorder remains a possibility, despite the negative serology.

Very difficult case, please post a follow up.

 

El 7/9/2004 23:37, Pedro Farinha dijo:

Is there a hepato/splenomegaly?

The BM has some features sugestive of a hemophagocytic syndrome (viral-related?).

Cumprimentos,

Pedro

 

El 9/9/2004 23:13, Isidro Machado dijo:

Médula hipercelular global con presencia de los 3 sistemas. Se observan células con citoplasma abundante acidofilo ??????.

Se ha realizado biopsia de piel????

Se deben realizar marcadores para mastocitos para excluir (Mast cell disease) con toma de la médula ósea.

Saludos

Dr. Isidro Machado y Dra Concepción Ochoa Ochoa

 

El 10/9/2004 6:35, Maria Jesus Coma dijo:

I agree with Dan Pankowsky: it's a very difficult case.

I think about an infectious process. In some pictures (as Figura_5 and Figura_8) I see cells that might be histiocytes with dark cytoplasmic points that may be microorganisms.

Did you rule out visceral leishmaniasis?

____________

Estoy de acuerdo con Dan Pankowsky: es un caso muy difícil. Me parece que pueda tratarse de un proceso infeccioso. En algunas imágenes (como en [ Figura_5 ] y [ Figura_8 ]) se ven células que pudieran ser histiocytes con puntos citoplásmicos oscuros que me sugieren microorganismos.

¿Se descartó una leishmaniasis visceral?

 

El 10/9/2004 20:44, David Cubero dijo:

Mielodisplasia.

Saludos, David

 

El 18/9/2004 18:06, Antonio Félix Conde dijo:

We are finishing the 2nd week after we opened the case of Dr Singh. Are there new clinical or pathological data? Perhaps new (and bigger) pictures would stimulate the discussion.

Regards,

Antonio Félix Conde

Hospital Can Misses

Ibiza

Spain

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