Bone marrow necrosis in paediatric patients: a diagnostic dilemma

Abstract

Bone marrow necrosis (BMN) is regarded as an infrequent and rare pathological finding in the aspirates and the trephine biopsies. It is a rare histological finding which may be associated with infections, sickle cell disease, leukemia and other diseases. Its postmortem prevalence ranges from 0.3% to 2.2%., BMN might also be seen prior to, or following a diagnosis of neoplasia, ordering subsequent treatments with chemotherapy or radiotherapy. Cellular elements can be masked by the extensive necrosis, leading to a non-diagnosis and can also precede the disease pathology before its presentation, which can lead to delay in accurate diagnosis. This study was done to highlight the rare findings of BMN and to scrutinize the underlying disease producing BMN after evaluating medical history, clinical presentation, laboratory findings and morphological analysis of bone marrow aspirations and biopsy. A cross-sectional observational study was done for a period of 3 years and this rare finding was observed only in five cases. This study indicates that the conditions associated with BMN are varied and malignancy remains common. BMN may precede or obscure the diagnosis, and repeat biopsies are indicated to secure a diagnosis. Pyrexia, bone pain, pancytopenia, elevated LDH and alkaline phosphatase levels are common associates of BMN.