Bone marrow dyspoiesis associated with severe refractory anaemia in liver cirrhosis

Abstract

Background and aimPeripheral cytopaenias and dyspoiesis are common in cirrhosis; however, the prevalence of dyspoiesis and its contribution in cirrhosis-related cytopaenias has not been studied. We aimed to study the bone marrow (BM) dyspoiesis and its impact on peripheral blood cell counts and refractory anaemia in patients with cirrhosis.Patients and methodsWe reviewed all the BM aspirates and biopsies of cirrhotic cases, done from 2011 to 2018 for clinical indications. Dyspoiesis was considered if >5% of the precursor cells of any of the three lineages showed dyspoietic changes. Primary haematological or non-haematological malignancies, chronic kidney disease, drug intake, acute and chronic hepatitis and granulomatous disease were excluded.ResultsOf 608 these, 82 cases (13.5%) showed dyspoiesis in the BM precursors. There was no difference in age (p=0.16), gender (p=0.58) and spleen size (p=0.35) in cases with or without dyspoiesis. Majority of the cases had dyspoiesis in erythroid series (62, 75.6%) and megakaryocytes (15, 18.2%). Dyspoiesis was more prominent in alcoholics 44 cases (53.6%) and autoimmune diseases 13 cases (15.8%). Erythroid hyperplasia (47.7±14.4 vs 40±11.1; p<0.001) was more in cases with dyserythropoiesis, indicating ineffective erythropoiesis. Patients with dyspoiesis had lower haemoglobin (7.5±1.9 vs 9.3±2.2 g/dL, p<0.001). 54 (8.07%) had refractory anaemia with dyspoiesis present in 48 (88.8%) (p<0.01). Dyspoiesis was independently associated with refractory anaemia when adjusted for age, gender, aetiology and liver disease severity.ConclusionsBM dyspoiesis, especially dyserythropoiesis, is associated with severe refractory anaemia in patients with cirrhosis and requires new therapeutic approaches.

Bone Marrow Assessment in Liver Cirrhosis Patients with Otherwise Unexplained Peripheral Blood Cytopenia

“…Since we included only patients with peripheral blood cytopenia, the frequency and severity of peripheral blood cytopenias in our cohort were higher than those reported in studies that included all patients with advanced liver cirrhosis [ 24 ]. In agreement with our findings, the limited number of available reports on bone marrow assessment in patients with liver cirrhosis likewise identified non-specific or reactive changes that did not meet diagnostic criteria for primary bone marrow pathologies in most cases [ 25 , 26 , 27 , 28 ]. To our knowledge, our study is the first to report results of a comprehensive, combined cytologic, histologic and immunologic bone marrow assessment in patients with liver cirrhosis and peripheral blood cytopenia.…”

CEACAM-1 Induced CSF3-receptor Downregulation in Bone Marrow Associated With Refractory Neutropenia in Advanced Cirrhosis

“…BM examination was performed as per the clinical indications, i.e., cytopenia, pyrexia of unknown origin, and dyserythropoiesis in refractory anemia as described in our previous study. 6 Clinical indications were similar across the Child-Turcott-Pugh (CTP) classes ( Supplementary Table 1 ). In these cirrhosis patients, the major etiology was ethanol-related, followed by viral, nonalcoholic steatohepatitis, and cryptogenic.…”

CSF3-Receptor Downregulation in Bone Marrow contributes to Ineffectiveness of GCSF in Advanced Liver Cirrhosis

“…Study group: The study included cirrhotic patients who underwent clinically indicated bone marrow (BM) examinations from Jan 2017 -June 2019 at the Institute of Liver and Biliary Sciences, New Delhi (n=127). BM examination was done as per the clinical indications {(i.e., cytopenia, pyrexia of unknown origin, and dyserythropoiesis in refractory anemia in our previous study [13]}. The clinical indications across the CTP A, B, and C categories were similar [Table S1].…”