Increased hematogones in an infant with bicytopenia and leucocytosis:a case report

Abstract

Hematogones are the normal bone marrow constituents of bone marrow in children and their number decreases with age. As hematogones can resemble malignant lymphoblasts by their morphologic features and by expression of an immature B-cell phenotype, an accurate distinction of hematogone-rich lymphoid regeneration from leukemic lymphoblasts is critical for patient care. The increased number of hematogones had been reported in the bone marrow of children recovering from chemotherapy, aplastic conditions, other forms of bone marrow injury, infections like Cytomegalovirus, HIV and immune thrombocytopenia disorders. We describe here a case of one and half month old male infant with bicytopenia and leucocytosis associated with increased hematogones in the bone marrow due to an unknown probable viral infection.

Analysis of hematogones in bone marrow from acute myeloid leukaemia cases posttherapy

“…Bone marrow (BM) hematogones (HGs) are variably detected in human BM specimens, and their numbers may change in a variety of diseases in both children and adults . The number of bone marrow HGs is often increased significantly in patients recovering from chemotherapy or other forms of bone marrow injury and in patients with nonhaematopoietic disorders .…”

Hematogones: The Supreme Mimicker and a Cytomorphological Confounder in Acute Lymphoblastic Leukemia

“…Neoplastic lymphoblasts may exhibit one or more aberrancies relative to normal B-lymphocyte precursors such as uniform expression of TdT and CD34; negative or underexpression of CD45, CD20, human leukocyte antigen-DR isotype (HLA-DR), and CD38; overexpression of CD10; an abnormal spectrum of CD22; and co-expression of CD34 and CD20. [11][12][13][14][15] FCA with combination of CD19/CD10/CD20/CD34/CD38 was efficiently used to differentiate the two depending upon the difference in the fluorescence intensity between blasts and HGs. [9][10][11]16 Among all these studies, a study by McKenna et al in year 2001 analyzed immunophenotypic characteristics of HGs in 662 consecutive bone marrow samples and stressed upon importance of FCA in delineating the uniqueness of HGs.…”

“…Neoplastic lymphoblasts may exhibit one or more aberrancies relative to normal B-lymphocyte precursors such as uniform expression of TdT and CD34; negative or underexpression of CD45, CD20, human leukocyte antigen-DR isotype (HLA-DR), and CD38; overexpression of CD10; an abnormal spectrum of CD22; and co-expression of CD34 and CD20. 11 12 13 14 15 …”

Is it Leukemia or Hematogone? (Case Report)

“…İnfantlarda ve yüksek doz kemoterapi sonrası kemik iliği rejenerasyonu sırasında görülebilirler. Hematogonlar ayrıca immün trombositopenik purpura (ITP), demir eksikliği anemisi, doğumsal nötropeni, doğumsal eritrosit aplazisi, bakır eksikliği, amegakaryositozisi kapsayan geniş bir hematolojik hastalık yelpazesinde görülebildiği gibi (2-4), Gaucher hastalığı, retinoblastom ve nöroblastoma gibi durumlarda da saptanabilmektedirler (5)(6)(7)(8). Bununla birlikte hematogonlar nedeni bilinmeyen viral enfeksiyonlar sonrasında da kemik iliğinde artmış oranda bildirilmiştir (1,5).…”

“…Morfolojik olarak blastlar ile hematogonları birbirinden ayırmak oldukça güçtür (5). Bu sunumda, lenfositoz nedeni ile izleme alınan, tanısında lösemi ve hematogon ayırımında güçlük çekilen bir vaka, lösemi tanısı konurken hematogonların dışlanması açısından dikkat edilmesi gerekliliğini vurgulamak amacı ile tartışılmıştır.…”