How to exhaust your bone marrow

Abstract

A 32-year-old man was admitted to the hospital because of oedema and 8 kg of gained weight. The oedema decreased spontaneously over weeks and there was no evidence for a nephrotic syndrome; however, the blood tests revealed a moderate pancytopenia. The patient practiced excessive physical activity at work and in his spare time, and kept a very thorough training and weight diary. Owing to a high intake of energy and protein drinks he tried to optimise his physical performance and kept a normal body mass index at 23.7. A bone marrow biopsy showed gelatinous bone marrow transformation, normally seen in critically ill patients or those with severe malnutrition. In this case, the cause is presumed to be excessive physical activity/overtraining in combination with relatively insufficient nutrition.

Bone in Anorexia

“…The corresponding MRI changes have been the subject of many case reports 19 20 21 and a few series. 22 23 T1-weighted sequences show diffuse homogeneous hyposignal in bone and extraosseous adipose tissue, notably including subcutaneous fat, while T2 fat-saturated or short tau inversion recovery sequences show abnormally intense signal ( Fig.…”

Gelatinous transformation of the bone marrow

“…About 11.4% of the etiologies were represented by other causes, such as iron deficiency, renal failure, psychoses, and myelodysplastic syndrome. Etiologies mentioned by other studies [2][3][4][5][6]8 include renal failure, 3 disseminated tuberculosis, alcoholic pancreatitis, 5 systemic lupus erythematosus, 2,4 excessive physical activity, 6 and non-specified eating disorders. 8 The possibility of other hypotheses to explain the physiopathology of this phenomenon 1,3 include the existence of GTBM in other diseases without the obligatory association with malnutrition, and patients with severe anorexia nervosa whose bone marrow does not develop this transformation.…”

“…2 GTBM is a histological pattern, which is mainly presented in the context of nutritional deprivation, such as anorexia nervosa, severe malnutrition, or cachexia. 6 Other clinical scenarios are malabsorption, alcoholism, 7 severe infections, 3 congestive heart failure, and acute febrile states. 1 Böhm 2 studied 155 patients with GTBM and realized that the etiologies varied according to the age of the patient.…”

Gelatinous transformation of bone marrow

“…About 11.4% of the etiologies were represented by other causes, such as iron deficiency, renal failure, psychoses, and myelodysplastic syndrome. Etiologies mentioned by other studies2 - 6 , 8 include renal failure,3 disseminated tuberculosis, alcoholic pancreatitis,5 systemic lupus erythematosus,2 , 4 excessive physical activity,6 and non-specified eating disorders 8…”

“…GTBM is a histological pattern, which is mainly presented in the context of nutritional deprivation, such as anorexia nervosa, severe malnutrition, or cachexia. 6 Other clinical scenarios are malabsorption, alcoholism, 7 severe infections, 3 congestive heart failure, and acute febrile states. 1 …”