Gelatinous Transformation of Bone Marrow in Patients with Anorexia Nervosa

Abstract

A 33-year-old woman with anorexia nervosa was referred to our hospital because of pancytopenia. Her weight was 31.6 kg (BMI, 12.3), and the laboratory results were as follows: a hemoglobin level of 5.9 g/dL, a red-cell count of 1,620,000/mm, a white-cell count of 1,200/mm, and a platelet count of 78,000/mm. An examination of the bone marrow aspirates revealed severe hypoplasia of the hematopoietic and fat cells along with a deposition of amorphous eosinophilc fluffy substances (Picture A-C). These distinct findings were described as gelatinous transformation, and were presumed to be a consequence of her severe malnutrition (1). The gelatinous material was composed of mucopolysaccharides, which were rich in hyaluronic acid (2). Trilineage hematopoietic maturation without apparent dysplasia or neoplasm was sparsely noted (Picture D). Her peripheral blood counts recovered following the administration of cautious nuturitional therapy.