PubMed · 5262403
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1970. Bone marrow studies.. https://pubmed.ncbi.nlm.nih.gov/5262403/
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A 64-year old female had been diagnosed as having thrombotic thrombocytopenic purpura (TTP; Moschcowitz syndrome) in 1984. The initial episode and one recurrence 5 years later were successfully treated with fresh plasma transfusions without plasmapheresis. Two days before the present admission, she noticed pain in the knee and haematomas in both legs. Marked thrombocytopenia (9000/microliters), haemolytic anaemia (lactate dehydrogenase 1800 U/l, haemoglobin 7.8 g/dl, haptoglobin 5 mg/dl) and skin haemorrhages suggested a second recurrence of TTP. The blood film showed a massive increase in fragmented cells (more than 30 per field), microspherocytes and normoblasts. Thrombocyte values initially rose on daily treatment with plasmapheresis using membrane separation and fresh plasma exchange. However, after two attempts at stopping therapy, plasmapheresis and fresh plasma replacement failed to normalise thrombocyte values. The patient had a total of 44 plasmaphereses. Intravenous administration of three doses of 1.5 mg vincristine at intervals of 7 and 5 days combined with further plasmapheresis treatment soon led to normalisation of the thrombocyte count (320,000/microliters), a fall in lactate dehydrogenase (120 U/l) and a disappearance of fragment cells in the blood smear. The patient is still in complete remission 6 months after stopping treatment. Treatment with vincristine should be considered for TTP refractory to treatment.
In the UK Hodgkin's disease is usually treated by either clinical oncologists or haematologists. A national study of the performance of bone marrow examination in newly diagnosed Hodgkin's disease was undertaken to establish current practice. A total of 620 questionnaires were despatched, and replies were received from 60% of consultants (45% of clinical oncologists and 70% of haematologists). Bone marrow examination was performed in all new cases significantly more often by haematologists than by clinical oncologists (74% vs 40%, P < 0.001). Among haematologists, there was no correlation between the number of new patients seen annually and practice, however clinical oncologists were even less likely to perform routine bone marrow biopsies if they saw more than ten patients per year (P < 0.02). Where bone marrow examination was performed selectively, the most common criteria used were peripheral blood cytopenia and advanced-stage disease. These criteria were applied in the same way by both clinical oncologists and haematologists. Bone marrow biopsy, an invasive and often painful procedure, is currently performed more frequently in Hodgkin's disease than can be recommended on the basis of recent studies in the literature and associated guidelines. There is a significant difference in practice between clinical oncologists and haematologists, and this raises the wider issue of the influence of hospital specialisation on patient management.
A case of IgA multiple myeloma associated with myelofibrosis and radiological evidence of diffuse osteosclerosis from the disease onset is reported. Bone marrow trephine biopsies performed before and after chemotherapy treatment for myeloma showed grade 4 collagen fibrosis of the bone marrow, thickened bony trabeculae and the presence of plasma cells, both mature and immature. Serum electrophoresis revealed an IgA lambda-paraprotein. Throughout the course of the disease, there was persistent radiological evidence of osteosclerosis, although several lytic lesions appeared late in the disease process. The patient died 5 years after presentation, during an episode of septicaemic shock. It is speculated that cytokine(s) released by the neoplastic plasma cells may stimulate a fibroblastic reaction within the marrow, which subsequently undergoes bony metaplasia resulting in osteosclerosis.