The differential diagnosis of polycythaemia--a bone marrow study (the bone marrow in polycythaemia)

Bone marrow sections from posterior iliac crest aspiration and/or trephine specimens have been examined in 39 patients with true polycythaemia, along with a variety of other clinical and laboratory data. The emphasis has been on objective assessment of cellularity and megakaryocyte concentration in a prospective four year study. In patients with untreated primary polycythaemia mean cellularity was 87.0% and 86.4% for aspirate and trephine specimens compared with 55.5% and 48.7% for secondary cases and 48.3% and 45.5% for controls. Eighty per cent of primary polycythemia patients had moderate to marked megakaryocytic hyperplasia. We conclude that, in the presence of an elevated red cell volume, marrow cellularity of greater than 75%, particularly when accompanied by megakaryocytic hyperplasia, of iliac crest aspirate or trephine specimens is sufficient per se to establish a diagnosis of polycythaemia rubra vera.     

Parenteral nutrition in bone marrow transplantation

Twenty-nine patients undergoing bone marrow transplantation (BMT) were randomised prospectively to evaluate the effect of parenteral nutrition (TPN) on morbidity and mortality. Fourteen patients received a standard regimen of TPN for 10 +/- 4 days (mean +/- SD). All patients had free access to oral diet, which was significantly reduced compared to pre-transplant intake. In the TPN group, serum bilirubin by day 14 and serum bilirubin and gamma glutamyl transferase by day 21 were significantly higher than in the controls (p < 0.05). These differences probably reflect the higher incidence of serious pyrexia (T > 38.5' C) and blood culture positive rates in the TPN group. Weight loss in the control group was significantly greater than that of the TPN group (p < 0.05). TPN did not affect time to grafting or incidence of graft-versus-host disease. The use of TPN in the nutritional support of patients in small BMT units requires careful consideration.     

[Long-term bone marrow culture]

Long-term bone marrow culture is an experimental in vitro model of hematopoiesis imitating conditions in vivo. It contains hematopoietic elements at various stages of differentiation as well as a supportive stromal microenvironment. Primitive hematopoietic stem cells of mesenchymal origin, the long-term culture initiating cells proliferate and differentiate into different cell types, giving rise to the adherent stromal layer and to various hematopoietic elements attached to it or floating freely in the supernatant medium. The stromal layer keeps the hematopoietic cells aggregated, helps their mitosis, differentiation and maturation by cell-to-cell contact, produces hematopoietic growth factors (cytokines), and forms the extracellular matrix required for cell attachment. Hematopoiesis occurs without exogenous growth factors. The appearance and development of the stroma, the proliferation and differentiation of hematopoietic progenitor cells, and the production of cytokines differ in long-term cultures of the normal and of pathologically altered bone marrow. Long-term bone marrow culture is applied in fundamental studies of normal and pathologically altered hematopoiesis, in pharmacological research, in the purging of residual leukemia cells from bone marrow autotransplants, and in the gene transfer. It is also suitable for testing carcinogenic and toxic chemicals causing hematopoietic damage through occupational or habitual exposure.     

Psychological and social preparation for bone marrow transplantation

Bone marrow transplantation (BMT) is a treatment for some malignant conditions which is considered both physically and psychologically demanding. This paper considers the impact of an intervention aimed at encouraging patients to be more involved in their own transplant preparation. A social research design was used to explore the psychosocial impact of BMT. Qualitative and quantitative data collection methods were used to survey 25 intervention-group and 229 comparison-group respondents. After controlling for identified confounding factors, comparisons were made between these groups. Contrary to expectation, no statistically significant differences were observed between the two groups on the outcome measures. However, when matched for categorical confounding factors, the intervention group had statistically significant improvement on "preparation," "post-transplant problems" and "anxiety" measures. The intervention group were also found to have higher scores on the "helplessness" and "fatalism" scales. The qualitative analyses suggest that this may have been due to a combination of raised expectations and non-encouraging hospital staff. Factors contributing to poor post-transplant adjustment were identified, as well as less problematic experiences common to the majority of transplant patients.     

Glutamine supplementation in bone marrow transplantation

An increasing number of clinical investigations have focused on supplementation of specialized enteral and parenteral nutrition with the amino acid glutamine. This interest derives from strong evidence in animal models and emerging clinical data on the efficacy of glutamine administration following chemotherapy, trauma, sepsis and other catabolic conditions. Glutamine has protein-anabolic effects in stressed patients and, among many key metabolic functions, is used as a major fuel/substrate by cells of the gastrointestinal epithelium and the immune system. These effects may be particularly advantageous in patients undergoing bone marrow transplantation (BMT), who exhibit post-transplant body protein wasting, gut mucosal injury and immunodeficiency. Studies to date indicate that enteral and parenteral glutamine supplementation is well tolerated and potentially efficacious after high-dose chemotherapy or BMT for cancer treatment. Although not all studies demonstrate benefits, sufficient positive data have been published to suggest that this nutrient should be considered as adjunctive metabolic support of some individuals undergoing marrow transplant. However, BMT is a rapidly evolving clinical procedure with regard to the conditioning and supportive protocols utilized. Thus, additional randomized, double-blind, controlled clinical trials are indicated to define the efficacy of glutamine with current BMT regimens.     

Current role and status of bone marrow transplantation

The applications of bone marrow transplantation have been limited by the serious morbidity and mortality associated with the procedure. In this article we discuss improvements in our understanding of the immunobiology of marrow transplantation. We also describe how the availability of recombinant growth factors for the haemopoietic and immune systems and the introduction of immunomodulatory monoclonal antibodies are beginning to make a major impact on the practice and outcome of the procedure.     

骨髓活检在诊断骨髓转移瘤中的价值

目的探讨骨髓活组织检查在诊断骨髓转移瘤中的价值。方法骨髓转移瘤患者行一步法骨髓抽吸取材,活检塑料包埋切片行HGF、Gomori染色,骨髓涂片行瑞特氏染色。结果骨髓活检检出率为97.1%,骨髓涂片检出率为60.9%,骨髓活检与骨髓涂片诊断相符率为57.9%;骨髓活检检出率明显高于骨髓涂片(P<0.01)。结论骨髓活检可作为诊断骨髓转移瘤的常规检测手段。