Bone Marrow Reactions to Trauma Stimulation of Erythropoietic Marrow by Mechanical Disruption, Fracture or Endosteal Curettage

Abstract

AbstractThe present series of studies were designed to examine the effect of artificially altered bone blood flow on activity of the contained marrow. In normal animals bone blood flow was increased locally by fracture, endosteal curettage, and following mechanical disruption of the marow. Local stimulation of erythropoietic marrow was demonstrated following each procedure. Local injury to bone circulation followed high doses of radiation and resulted in permanent marrow aplasia.Attempts to apply the implications of these studies to therapy of two patients with marrow failure produced inconclusive results. One patient with severe anemia due to idiopathic myelofibrosis improved abruptly and significantly following endosteal curettage of one femur. Unexpectedly there was no demonstrable increase in blood flow in the operated bone and improvement in marrow occurred in skeletal areas other than the operative site.In a second patient with severe anemia and Fanconi's syndrome, endosteal curettage of one femur resulted in a marked local increase in bone blood flow with no evidence of stimulation of marrow locally or at other sites and no improvement in clinical condition until institution of androgen therapy.Further clinical trials of endosteal curettage as a therapeutic measure would appear to be justified.