The Bone Marrow in AIDS: A Histologic, Hematologic, and Microbiologic Study

Abstract

During one year, 55 bone marrow biopsies from 49 patients with CDC-defined acquired immune deficiency syndrome (AIDS) were studied. Eighty-three percent were normocellular or hypercellular; 17% were hypocellular. Marrow plasma cells were increased in 83% of patients, most showing polyclonal hypergammaglobulinemia. Forty percent of patients showed peripheral neutropenia, 29% thrombocytopenia, and 79% lymphopenia with markedly reduced T4+ lymphocytes. Eighty-five percent of patients were anemic, with iron studies showing a pattern consistent with the anemia of chronic disease. Mycobacterium avium-intracellulare (MAI) grew from ten (20%) biopsies, four with granuloma and six without granuloma (five of these six also showed marrow hypocellularity). Small poorly formed granuloma (70-150 micron) were seen in eight (16%) patients (four AFB-culture positive, 4 negative). Three of four granuloma-positive, culture-negative cases eventually grew MAI from autopsy material. Five (10%) patients had lymphoplasmacytic aggregates; later, one developed lymphoma, another, markedly atypical lymphoid hyperplasia. Two additional patients showed marrow B-cell lymphomas. Of these findings, only marrow MAI meets the CDC definition of AIDS. However, in this series, small ill-defined granulomas, lymphoplasmacytic aggregates, and B-cell lymphomas also were found. The authors conclude that these latter findings, when seen in high-risk patients, particularly those with lymphopenia, anemia, and/or hypergammaglobulinemia, also strongly suggest the diagnosis of AIDS.

Study of Skin Staples and Conventional Suture for Abdominal Skin Wound Closure

“…Bone marrow picture in our study were normocellular in majority of patients, as encountered in other studies 1,9,10 . Hypocellular bone marrow was detected in 21.33% of patients and was found more common in AIDS than Non-AIDS patients.…”

Paraproteinemia, plasmacytoma, myeloma and HIV infection

“…9 Bone marrow biopsy of HIV-infected patients commonly reveals a plasmacytosis, even in the absence of any plasma cell disorder. 1,10 A distinct but related phenomenon less frequently observed in AIDS patients is mono-or oligoclonal gammaglobinopathy. Briault and co-workers 11 observed mono-or oligoclonal antibodies in the sera of 26% of 62 HIV-positive patients at various stages of infection.…”

Bone Marrow Morphologic Findings in Patients with Human Immunodeficiency Virus (HIV) Infection

“…While several studies 2123 " 26 have compared similar bone marrow findings in HIV-infected patients to those seen in myelodysplastic syndrome, others have found no characteristic dysplastic bone marrow features in these patients. 6,12,19,24,27 In this study, mild to moderate dyserythropoiesis was seen in 44% of the bone marrow, but myelodysplasia of all cell lines was an uncommon finding. The dysplasia that was seen in the bone marrow of the three patients with lymphomas may not have been directly caused by HIV infection.…”

“…21 A variety of bone marrow morphologic findings in patients with HIV infection have been reported from many parts of the world. 6 " 16 For the most part, bone marrow examinations have been performed in patients with advanced HIV disease and clinically indicated reasons, and although it appears that bone marrow abnormalities occur with increasing frequency as HIV infection progresses, their occurrence among all HIV-infected patients and the chronologic order of involvement has not yet been elucidated. Additionally, as most of these studies involved adult patients with HIV infection, the data for children remains rather limited.…”

“…5 Several studies have reported the hematologic and morphologic bone marrow findings in patients with HIV infection in Western countries. [6][7][8][9][10][11][12][13] Most of the changes are nonspecific and may be due to the virus itself, to drugs used in the treatment of these patients, or to opportunistic infections and immunologic causes. On the other hand, certain changes, such as an increased number of naked or denuded megakaryocyte nuclei, seem to be specific for HIV infection.…”