Severe Anaemia with Unusual Blasts in the Bone Marrow

Abstract

This Quiz refers to an iliac crest biopsy performed in a 32-year-old man suffering from haemolytic anaemia. Deficiency of glucose 6-phosphate dehydrogenase was known in this patient for many years. Due to an acute haemolytic crisis accompanied by pancytopenia he had to be hospitalised. The clinical examination revealed a haemoglobin concentration drastically decreased to 5g/dl, whereas the reticulocyte count was reported to be slightly subnormal with an actual value of 1.2%. The blood concentration for lactate dehydrogenase was significantly increased up to 500 D/ml: Leucocytes (2.3 X 109 1) and platelets (87 x 109 1) were both decreased in number. The trephine biopsy taken from the iliac crest consisted of a cylinder of cancellous bone measuring 30 mm in length. The specimen was fixed in a mixture of glutaraldehyde (0.5% v/v), formaldehyde (1.2% v/v) and calcium acetate (1.85% w/v), subsequently decalcified in neutral EDTA and embedded in paraffin. Sections were stained with Giemsa, Gomori and PAS according to routine procedures, and for chloroacetate esterase and tartrate resistant acid phosphatase1. The cancellous bone did not show any signs of an enhanced turnover. By means of the tartrate resistant acid phosphatase reaction only very few inactive osteoclasts