Sternal Bone Marrow Aspiration Research Articles

An in vitro model for discovery of osteoclast specific biomarkers towards identification of racehorses at risk for catastrophic fractures.

Focal bone microcracks with osteoclast recruitment and bone lysis, may reduce fracture resistance in racehorses. As current imaging does not detect all horses at risk for fracture, the discovery of novel serum biomarkers of bone resorption or osteoclast activity could potentially address this unmet clinical need. The biology of equine osteoclasts on their natural substrate, equine bone, has never been studied in vitro and may permit identification of specific biomarkers of their activity. (1) Establish osteoclast cultures on equine bone, (2) Measure biomarkers (tartrate resistant acid phosphatase isoform 5b [TRACP-5b] and C-terminal telopeptide of type I collagen [CTX-I]) in vitro and (3) Study the effects of inflammation. In vitro experiments. Haematopoietic stem cells, from five equine sternal bone marrow aspirates, were differentiated into osteoclasts and cultured either alone or on equine bone slices, with or without a pro-inflammatory stimulus (IL-1β or LPS). CTX-I and TRACP-5b were immunoassayed in the media. Osteoclast numbers and bone resorption area were assessed. TRACP-5b increased over time in osteoclast cultures without bone (p < 0.0001) and correlated with osteoclast number (r=0.63, p < 0.001). CTX-I and TRACP-5b increased with time for cultures with bone (p=0.002; p=0.02 respectively), correlated with each other (r=0.64, p < 0.002) and correlated with bone resorption (r=0.85, p < 0.001; r=0.82, p < 0.001 respectively). Inflammation had no measurable effects. Specimen numbers limited. Equine osteoclasts were successfully cultured on equine bone slices and their bone resorption quantified. TRACP-5b was shown to be a biomarker of equine osteoclast number and bone resorption for the first time; CTX-I was also confirmed to be a biomarker of equine bone resorption in vitro. This robust equine specific in vitro assay will help the study of osteoclast biology.

Sternal aspirate sampling of Bacillariophyceae (diatoms) and Cyanobacteria in suspected drowning cases

A diagnosis of drowning is not always possible based on the traditional autopsy findings. The most widely used ancillary methods are based on the detection of diatoms and other waterborne organisms in the organs of the systemic circulation by light microscope or polymerase chain reaction (PCR). One of the greatest concerns is sample contamination. Bone marrow is a favourable source because the compact bone protects the sample from water ingress in the case of advanced decay.In our pilot study, we aimed to adopt sternal bone marrow aspiration - which is a widely used technique in haematology - for postmortem sampling.Control experiments of non-drowning victims showed that cleaning the skin over the sternum can prevent external contamination.Sternal aspirate samples were taken from seven suspected drowning victims along with lung, spleen, and femoral bone marrow samples. All specimens were examined for the presence of diatoms by light microscope and Cyanobacteria-specific DNA by PCR.We were able to obtain bone marrow aspirates from all cases without complications. In four of the sternal samples both diatoms and cyanobacterial DNA were detected, while one additional sternum sample was tested positive with PCR, but no diatom shells were detectable.Sternal bone marrow aspiration is simple and quick, which can be performed at the beginning of an autopsy, minimizing the chance of contamination. We have shown that this sampling method can be adopted for postmortem diatom testing. This minimally invasive technique might be used in virtual autopsy (postmortem computed tomography, PMCT) settings without opening body cavities.

Cathepsin K Localizes to Equine Bone In Vivo and Inhibits Bone Marrow Stem and Progenitor Cells Differentiation In Vitro

Selective inhibition of Cathepsin K (CatK) has a promising therapeutic potential for diseases associated with bone loss and osseous inflammation, such as osteoarthritis, periodontitis, and osteoporosis. In horses, stress-related bone injuries are common and accompanied by bone pain and inflammation resulting in excessive bone resorption and periostitis. VEL-0230 is a highly selective inhibitor of CatK that significantly decreased bone resorption and increased bone formation biomarkers. The goal of this study was to demonstrate the presence of CatK in equine bone and a simultaneous influence on the bone marrow cellular components including function and differentiation. Our objectives were: 1) to investigate the tissue localization of CatK protein in equine bone using immunohistochemistry, and 2) to determine the effect of CatK inhibition on osteoclastogenic, chondrogenic and osteogenic differentiation potential of equine stem and progenitor cells in vitro using histochemical staining and differentiation-related gene expression analyses. Bone biopsies, harvested from the tuber coxae and proximal phalanx of six healthy horses, were processed for immunostaining against CatK. Sternal bone marrow aspirates were cultured in 0, 1, 10, or 100 μM of VEL-0230 and subsequent staining scoring and gene expression analyses performed. All cells morphologically characterized as osteoclasts and moderate number of active bone lining osteoblasts stained positive for CatK. Histochemical staining and gene expression analyses revealed a significant increase in the osteoclastogenic, chondrogenic and osteogenic differentiation potential of equine bone marrow cells, which was VEL-0230-concentration dependent for the latter two. These results suggested that CatK inhibition may have anabolic effects on bone and cartilage regeneration that may be explained as a feedback response to CatK depletion. In conclusion, the use of CatK inhibition to reduce inflammation and associated bone resorption in equine osseous disorders may offer advantages to other therapeutics that would require further study.

Participation of ticks in the infectious cycle of canine visceral leishmaniasis, in Teresina, Piauí, Brazil.

In this study, we detected Leishmania spp. infection in R. sanguineus collected from dogs that were naturally infected with L. (L.) infantum. We examined 35 dogs of both sexes and unknown ages. The infected dogs were serologically positive by the immunofluorescence antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA), and Quick Test-DPP (Dual Path Platform), as well as parasitological examination of a positive skin biopsy or sternal bone marrow aspiration. Ten negative dogs were included as controls. The ticks that infested these dogs were collected in pools of 10 adult females per animal. The PCR was performed with specific primers for Leishmania spp., which amplified a 720-bp fragment. Of the 35 analyzed samples, a product was observed in eight samples (8/35; 22.9%). We conclude that the presence of parasite DNA suggests that ticks participate in the zoonotic cycle of canine visceral leishmaniasis, in the city of Teresina, Piauí.

Sternal bone marrow is a suitable autologous cell source for cardiac stem cell therapies

Background: Autologous intramyocardial transplantation of CD133 positive bone marrow derived stem cells (BMSC) is currently investigated in cardiac regenerative therapy. Since sternal bone marrow is readily accessible during cardiac surgery procedures, it might be a suitable source for autologous stem cell harvest. However, little is known about the factors influencing stem cell yield and quality after sternal bone marrow aspiration.

Secondary Hepatocellular Carcinoma Following Hepatic Infiltration of Chronic Lymphocytic Leukemia

Purpose: A 75-year-old Hispanic female from Puerto Rico, who presented to our hospital in 2008 for oncology evaluation. She had been diagnosed of chronic lymphocytic leukemia (CLL) 4 months earlier. This was confirmed by a sternal bone marrow aspiration. At that time, she was completely asymptomatic and had no palpable lymphadenopathy. Other pertinent past medical histories were diabetes mellitus, hypertension, hyperlipidemia, and migraine headaches. Laboratory exams were notable for mild lymphocytosis. Flow cytometry showed typical CLL with CD 19+/CD5+ (co-expression), CD20+ (dim), CD23+, CD38- and kappa light chain+ (dim), 0% of ZAP 70 positive. Bone marrow cytogenetics showed normal karyotype. Since her presentation, she had an abnormal elevation in alkaline phosphatase that ranged from 288 U/L to 440 U/L. Hepatitis C antibody and hepatitis B surface antigen were negative. All work-up for chronic liver disease was negative. She underwent a liver biopsy, which showed liver parenchyma with a patchy infiltrate of small lymphocytes expressing CD20, PAX-5, CD5, CD23, CD43, and BCL-2 characteristic of B-small lymphocytic lymphoma/chronic lymphocytic leukemia. Serial CT scans showed progressive intra-abdominal lymph node affectation; however, she did not meet criteria for treatment for her CLL, as her WBC count, as well as other markers of disease activity remained stable. In 2012, as part of the routine evaluation of her progressive intra-abdominal lymphadenopathy, an abdominal CT scan showed an 8-cm liver mass. Though initially asymptomatic, she developed a right upper quadrant pain that was severe, associated with malaise, constipation, and loss of appetite. Physical examination showed submandibular lymphadenopathy and right upper quadrant tenderness. She had no peripheral stigmata of chronic liver disease. The presence of a large liver mass with an underlying history of liver biopsy being positive for CLL/B-lymphocytic lymphoma made a suspicion of a rapidly growing lymphoma likely. Alpha fetoprotein was also normal. She underwent a second liver biopsy that now revealed grade II hepatocellular carcinoma (HCC). Being Child-Pugh stage B, with a huge liver mass and maintaining a good functional status, she only met the Barcelona Clinic Liver Cancer (BCLC) criteria for treatment with sorafenib, which she was started on, but tolerated for only few weeks. Unfortunately, she continued to decline while the tumor increased exponentially. She was eventually placed in a hospice, and died 3 weeks later. There may be a real association between HCC and CLL. Future studies are required to establish evidence and the goals of treatment.

Comparison of sternal, iliac, and humeral bone marrow aspiration in Beagle dogs

Sternal bone marrow aspiration in dogs is not commonly performed as it is considered technically challenging in smaller dogs. However, the sternum is readily accessible and associated with less pain from aspiration compared with other sites. The aim of the study was to investigate feasibility, ease, number of attempts, safety, and sample quality of sternal bone marrow aspirates in small dogs. Bone marrow aspirates were obtained in a randomized order from 3 sites in 26 clinically healthy Beagles under general anesthesia. Samples were obtained from the sternum using one-inch 20- or 22-gauge hypodermic needles, from the right greater tubercle of the humerus, and the right iliac crest using 18-gauge Illinois needles. The difficulty of each procedure was scored. Two types of bone marrow smears were prepared and reviewed by a pathologist unaware of site of aspiration or dog. The number of particles per slide and overall slide quality were scored. The site of aspiration and the cranial thoracic wall were evaluated at autopsy for evidence of trauma or pneumothorax. The number of attempts and time for bone marrow aspiration were greater for ilium than for sternum or humerus, but the sternum was the easiest to aspirate. Smear quality and particle number were similar for all sites. Neither trauma at the site of aspiration nor pneumothorax were identified. Aspiration of sternal bone marrow with hypodermic needles is feasible and safe in Beagle dogs. Samples equivalent in quality to those from the humerus or ilium can be obtained from clinically normal dogs.

Risk Factors Concerning Sternal Bone Marrow Aspiration and Patient Safety in Japan

Several reports have described adverse events resulting from sternal bone marrow aspiration procedures. We hypothesized about inevitable lacerations to the ascending aorta that occur from structural abnormalities in the needle passage. We evaluated dimensions in the thorax related to the sternal bone marrow aspiration, using a chest CT scan on a display terminal. Patients Among the 3,848 patients who visited our institution and underwent a chest CT scan between September 1, 2007 and December 31, 2008, a total of 153 subjects showing no particular chest CT findings were enrolled. Significant variation was observed in the distance from the sternum to the ascending aorta, from a minimum of 4.2 to a maximum of 47.6 mm (median 23.6) in men and a minimum of 5.2 to a maximum of 38.4 mm (median 21.3) in women. There were three men (3.6%) and women (4.3%) each having a distance within 10 mm. Our findings showed for the first time that an anterior chest approach to sternal bone marrow aspiration involves an inevitable risk of laceration of the ascending aorta, when the needle tip penetrates the sternum. Our analysis of dimension also suggested that the sternal marrow aspiration procedure involved a greater risk among older subjects of short stature.

Jamshidi needle Biopsy of the Sternal Bone Marrow.

Abstract 4548The aspiration and biopsy of the bone marrow is one of the most valuable and important tests in hematology, oncology and medicine. It is a high yield, safe, fast and informative test performed frequently in medical practice with minimal complications. For reasons of ease and safety, bone marrow aspiration and biopsy are usually obtained from the posterior iliac crest. I reviewed my experience in obtaining 37 consecutive bone marrow biopsies from the sternum using a Jamshidi needle (gauge 11; external diameter 3.048 mm) in 36 consecutive patients (twice in one patient) over a 9 year period, in whom a posterior iliac crest study could not be done. TechniqueAfter performing the sternal bone marrow aspiration in the usual manner, a small skin incision is made over the sternum with a scalpel. The Jamshidi needle is introduced at approximately a 90 degree angle in the middle of the sternum at the level of the 3rd intercostal space. After a ”give” is felt, indicating that the needle has reached the bone marrow cavity, the tip of the needle is angled downwards at 45 degrees or less and with a clockwise - counterclockwise movement, the needle is advanced for 3 to 10 mm. After a slight change of angle aiming at “breaking” the distal attachment of the bone marrow piece, the needle is slowly withdrawn with the same rotatory movements. In no case did I feel that I had reached the inner table of the sternum. All patients were observed and examined 20 minutes and 24 hours after the procedure. ResultsThere were 22 inpatient and 15 outpatient procedures. The reasons that precluded the performance of the preferred posterior iliac crest bone marrow biopsy were: immobility in 17 patients, obesity in 13, prior radiation in 3 and other in 4. The final diagnosis was a malignant disorder in 17 patients (leukemia, lymphoma, myelodysplasia, plasma cell dyscrasia or metastatic cancer). All but one were new diagnoses. In 20 cases the final diagnosis was a benign hematological disorder or a non diagnostic bone marrow examination. In 9 occasions (mostly obese patients and patients with prior radiation therapy) a previous attempt at performing a posterior iliac crest biopsy had failed. The only complications were the development of a tumor nodule in the needle tract in one patient with an aggressive, Burkitt's type lymphoma and a small superficial hematoma in a patient with a highly vascular metastatic breast cancer.The bone marrow core biopsy of the sternum, performed as described, in the hands of an experienced practitioner is a safe and helpful test in the evaluation of the bone marrow cytology, architecture and anatomy in selected patients in whom the performance of the preferred posterior iliac crest biopsy cannot be done. Disclosures:No relevant conflicts of interest to declare.

Cell Growth Characteristics and Differentiation Frequency of Adherent Equine Bone Marrow–Derived Mesenchymal Stromal Cells: Adipogenic and Osteogenic Capacity

To characterize equine bone marrow (BM)-derived mesenchymal stem cell (MSC) growth characteristics and frequency as well as their adipogenic and osteogenic differentiation potential. In vitro experimental study. Foals (n=3, age range, 17-51 days) and young horses (n=5, age range, 9 months to 5 years). Equine MSCs were harvested and isolated from sternal BM aspirates and grown up to passage 10 to determine cell-doubling (CD) characteristics. Limit dilution assays were performed on primary and passaged MSCs to determine the frequency of colony-forming units with a fibroblastic phenotype (CFU-F), and the frequency of MSC differentiation into adipocytes (CFU-Ad) and osteoblasts (CFU-Ob). Initial MSC isolates had a lag phase with a significantly longer CD time (DT=4.9+/-1.6 days) compared with the average DT (1.4+/-0.22 days) of subsequent MSC passages. Approximately 1 in 4224+/-3265 of the total nucleated BM cells displayed fibroblast colony-forming activity. Primary MSCs differentiated in response to adipogenic and osteogenic inductive conditions and maintained their differentiation potential during subsequent passages. The frequency, in vitro growth rate, and adipogenic and osteogenic differentiation potential of foals and young adult horses are similar to those documented for BM MSCs of other mammalian species. The results have direct relevance to the use of BM as a potential source of adult stem cells for tissue engineering applications in equine veterinary medicine.

Transplantation of mesenchymal stem cells from human bone marrow improves damaged heart function in rats

Background Bone marrow-derived mesenchymal stem cells (MSCs) are of great therapeutic potential after myocardial ischemic injury. However, little is known about the biological characteristics of MSCs in patients with coronary artery disease and their effects on infracted myocardium. The present study evaluated the biological characteristics of MSCs from patients with coronary artery disease and their effects after being transplanted into infarcted myocardium using a rat model. Methods Sternal bone marrow aspirates were taken at the time of coronary artery bypass graft surgery. Mononuclear cells isolated from bone marrow were cultured based on plastic adherence. The morphology and growth characteristics of MSCs were observed in primary and successive passages. A myocardial infarction model was created in 27 adult rats. Two weeks later, animals were randomized into two groups: culture medium (group I, n = 13) or MSCs (2 × 10 6) from early passages labeled with BrdU (group II, n = 14) were injected into the infarcted myocardium. Echocardiography, histological examination, and reverse transcription–polymerase chain reaction (RT–PCR) were performed four weeks after cell transplantation. Results Flow cytometry analyses demonstrated that adherent spindle cells from bone marrow are mesenchymal stem cells (positive for CD29 and CD44, but negative for CD34 and CD45). Growth curves showed that MSCs have great proliferative capability especially at early passages. MSCs implantation in the infarcted border zone improved left ventricular function significantly in group II compared with group I. However, despite improved left ventricular function, we did not observe significant regeneration of cardiac myocytes. Immunohistochemistry revealed only the expression of desmin in the engrafted MSCs, a marker of premature myocyte. Moreover, the improved left ventricular function in this study seemed to be secondary to the beneficial reverse remodeling induced by the increase of collagen in infarcted zone, the decrease in the adjacent myocardium, and the increase of neovascularization (capillary density: 192 ± 7.8/mm 2 in group II vs. 165 ± 5.9/mm 2 in group I, P < 0.05). Reverse transcription–polymerase chain reaction (RT–PCR) results showed the expression levels of collagen I, collagen III, SDF-1 (stromal cell-derived factor-1), and VEGF (vascular endothelia growth factor) in the infarcted border zone were significantly higher in the MSCs treated group. Conclusions The MSCs from patients with coronary artery disease have a typical phenotype with highly proliferative potential and the engrafted MSCs may regulate extracellular collagens and cytokines to prevent the ventricular scar from pathologic thinning and attenuate the contractile dysfunction of the infarcted heart.

Pneumopericardium in a horse secondary to sternal bone marrow aspiration

Pneumopericardium in a horse secondary to sternal bone marrow aspiration

Osteopromotion by a β-Tricalcium Phosphate/Bone Marrow Hybrid Implant for Use in Spine Surgery

Experimental animal study. OBJECTIVE.: Evaluate osteopromotive properties of a beta-tricalcium phosphate (TCP) implant with different osteogenic substances in an animal study. Current research in spine surgery is focusing on resorbable bone implants because of the high morbidity after iliac crest graft harvesting. Therefore, several osteoconductive scaffolds are combined with osteoinductive substances. In 14 sheep, a critical size defect was performed on both tibiae. The sheep were randomized into 3 groups (4 sheep each) and a control group (2 sheep). In the treatment groups, the defects were filled with the beta-TCP scaffold impregnated with either venous blood, bone marrow from sternal aspiration, or a concentrated mononuclear cell suspension derived from sternal bone marrow aspiration. The sheep in each group were euthanized 6 and 12 weeks after the operation; the investigation included quantitative computerized tomography and histology. The best bone formation occurred in the bone marrow group after 6 and 12 weeks, whereas no difference was found between the cell and venous blood groups. Only the bone marrow group showed bone formation inside the scaffold after 6 weeks. We conclude that a beta-TCP scaffold filled with bone marrow aspiration creates a biologic resorbable bone substitute with high osteopromoting capacity. Surprisingly, no better bone formation occurred in the concentrated cells group, which may be a result of technical reasons and needs to be further evaluated. The combination of beta-TCP and bone marrow has superior osteopromotive properties to venous blood or concentrated mononuclear cells and can be used effectively as a substitute to iliac crest graft.

A pathologist's perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination.

The bone marrow aspirate and biopsy is an important medical procedure for the diagnosis of hematologic malignancies and other diseases, and for the follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of medical therapy. During the procedure, liquid bone marrow is aspirated from the posterior iliac crest or sternum with a special needle, smeared on glass microscope slides by one of several techniques, and stained by the Wright-Giemsa or other techniques for micro-scopic examination. The bone marrow core biopsy is obtained from the posterior iliac crest with a Jamshidi or similar needle and processed in the same manner as other surgical specimens. Flow cytometric examination, cytochemical stains, cytogenetic and molecular analysis, and other diagnostic procedures can be performed on bone marrow aspirate material, while sections prepared from the bone marrow biopsy can be stained by the immunoperoxidase or other techniques. The bone marrow procedure can be performed with a minimum of discomfort to the patient if adequate local anesthesia is utilized. Pain, bleeding, and infection are rare complications of the bone marrow procedure performed at the posterior iliac crest, while death from cardiac tamponade has rarely occurred from the sternal bone marrow aspiration. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimens obtained.

Erythrocyte Ferritin in Patients with Chronic Renal Failure and Heterozygous Beta-Thalassemia

Aim: The aim of this research is to study the variance of erythrocyte ferritin (EF) in patients with chronic renal failure (CRF) and heterozygous β-thalassemia (β-TA), as well as the use of EF as a more reliable index for assessing the body iron status. Methods: We studied 63 subjects with CRF, 40 subjects with heterozygous β-TA, 53 subjects with CRF and heterozygous β-TA and 24 normal subjects. In 11 patients with CRF and heterozygous β-TA, sternal bone marrow aspiration was performed to evaluate iron stores in the bone marrow. EF was determined in the hemolysate of washed erythrocytes by a radioimmunoassay. Results: EF showed the strongest correlation with bone marrow iron (p < 0.001) in comparison with the remaining hematological parameters that were examined. Patients with CRF without heterozygous β-TA showed an increase in serum ferritin (SF), even in cases of iron deficiency. In the group of heterozygous β-TA without renal failure, 22.5% of patients showed an increased EF content up to 150 ag/cell and a tendency for iron overload. Patients with CRF and heterozygous β-TA showed a high value of EF, up to 200 ag/cell, and iron overload in 22.6%, almost the same proportion as in the previous group. It was also observed that a high value of SF does not indicate iron overload for these patients. In the group of hemodialysis, patients without heterozygous β-TA who were under erythropoietin (EPO) treatment presented iron deficiency. Many patients with CRF and heterozygous β-TA who were taking EPO presented iron overload, while very few of them presented iron deficiency. Conclusion: These findings suggest that EF is a reliable index for assessing the iron status in patients with CRF and heterozygous β-TA.

Platelet kinetic studies in patients with idiopathic thrombocytopenic purpura

PURPOSE: To determine the value in diagnosis and treatment of mean platelet life, platelet production, and major sites of platelet destruction in patients with idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHODS: Sternal or posterior superior iliac spine bone marrow aspiration was performed in 141 patients. Platelet kinetic studies with Indium-111 tropolonate labeled autologous platelets were utilized to determine platelet production. RESULTS: Two subgroups of patients could be defined. The first group (n = 81, 58%) had normal or increased platelet production and increased peripheral platelet destruction. These patients fulfilled the conventional criteria for ITP, including reduced platelet survival time (mean ± SD, 1.6 ± 1.4 days). Forty-eight (59%) of these patients had increased splenic sequestration and 30 (88%) of the 34 patients who underwent splenectomy had a complete or partial remission. The second group (n = 60, 42%) had decreased platelet production, with significantly greater platelet survival times (3.6 ± 2 days, P <0.0001). In this group, the proportion of patients with complete or partial response to splenectomy (62%) was somewhat lower ( P = 0.09). These patients mainly had ineffective platelet production in the bone marrow. CONCLUSIONS: Platelet kinetic studies suggest that ITP is a heterogeneous disease that comprises two subgroups. Further studies are needed to validate these findings and to determine their effect on the choice and outcome of therapy.

Thrombocytopenia in the Sepsis Syndrome: Role of Hemophagocytosis and Macrophage Colony-stimulating Factor

BACKGROUND: Thrombocytopenia is frequently encountered in critically ill patients with the sepsis syndrome, but its mechanisms frequently remain undetermined. Hemophagocytosis has been reported as a cause of thrombocytopenia in various diseases. This prospective study was designed to assess: (1) the incidence of hemophagocytosis in patients suffering from both the sepsis syndrome and unexplained thrombocytopenia, and (2) the circulating level of the macrophage-colony-stimulating factor (M-CSF) according to the presence or absence of hemophagocytosis.METHODS: Fifty consecutive patients diagnosed with both the sepsis syndrome and thrombocytopenia of undetermined origin were studied. Hemophagocytosis was diagnosed based on microscopical examination of sternal bone marrow aspiration by two independent observers. Serum M-CSF concentrations were measured in each patient and compared with levels of a normal population (n = 59). Causes and severity of sepsis syndromes as well as serum M-CSF levels were compared beween patients with and without hemophagocytosis.RESULTS: Hemophagocytosis was diagnosed in 32 patients (64%). Mean serum M-CSF levels were increased in patients when compared with normal subjects (539 ± 141 versus 208 ± 82 IU/mL: P <0.001), and higher in patients with than without hemophagocytosis (580 ± 145 versus 457 ± 89 IU/mL: P = 0.01). Multiorgan dysfunction and infection were independent risk factors of hemophagocytosis (odds ratio = 31.3 and 6.8, 95% confidence interval (CI) = 5.4 to 177.6 and 1.0 to 47.4, P <0.0001 and P = 0.03, respectively).CONCLUSIONS: Hemophagocytosis is a frequent cause of unexplained thrombocytopenia in patients with severe sepsis syndrome. Our results suggest that M-CSF is overproduced in the sepsis syndrome, particularly when hemophagocytosis is present. The role of M-CSF in the initiation and development of hemophagocytosis remains to be determined.

Evaluation of bone marrow cytology and stainable iron content in healthy adult llamas.

Complete blood counts and sternal bone marrow aspirates were obtained from healthy adult llamas ranging in age from 2.5 to 8.4 years. Megakaryocyte numbers and erythroid and myeloid series maturation and morphology appeared similar to other mammalian species. The particles contained 50 to 75% marrow cells with the remainder composed of lipocytes and stromal cells. In samples with numerous particles and adequate cellularity, M/E ratios ranged from 0.9 to 2.9. Samples with higher white blood cell counts and fewer particles had higher M/E ratios. Eosinophils comprised 14.3% of the myeloid series which is higher than other domestic mammals. Hemosiderin granules were numerous in marrow particles.

Diagnosis of iron deficiency.

ABSTRACTHaematological variables were studied in a randomised population sample of 372 38‐year‐old women resident in Gothenburg, Sweden during the period 1968–69. The participation rate was 91.4 %. The study was performed to evaluate the laboratory diagnosis of iron deficiency. The haematological investigation included determination of haemoglobin concentration, erythro‐cyte and reticulocyte counts, serum iron concentration, total iron binding capacity, packed cell volume, sternal bone marrow aspiration with estimation of stainable iron in the reticuloendothelial cells, sideroblast count, iron absorption test with 59Fe in a whole‐body counter and determination of menstrual blood loss. Serum ferritin concentrations were later determined on samples which had been frozen for 10 years. Eighty‐nine women with no or only traces of reticuloendothelial iron in the bone marrow completed a double‐blind supplementation trial, in which iron and placebo therapy were compared.Determination of stainable iron in the reticuloendothelial cells of the bone marrow was used as a direct method for the evaluation of iron stores. In 31.5 % of the women there was no reticulendothelial iron and in 14.3 % there were only traces. Of the indirect methods compared with the bone marrow method the serum ferritin concentration and iron absorption gave the highest correlations. A high correlation was also observed between menstrual blood loss and the content of reticuloendothelial iron. An arbitrarily chosen scale for the estimation of the amount of stainable reticuloendothelial iron in the bone marrow was used for these correlation analyses.The differences in mean corpuscular haemoglobin, transferrin saturation, sideroblast count, iron absorption, and menstrual blood loss were all highly statistically significant when the series of women with no or only traces of reticuloendothelial iron in the bone marrow were compared to those with clearly visible or abundant amounts of stainable iron. There were no significant differences concerning these variables between women who had no traces of stainable iron and those who had only traces of stain‐able iron. Increased iron absorption was found in women with a lack of stainable iron in the reticuloendothelial cells compared to women with stainable iron, irrespective of sideroblast count.The results from the iron supplementation study indicates that the haemoglobin concentration values of many of the women, although being within the normal range, were suboptimal for the individual woman. However, we considered it not possible to ascertain which women were responders to iron therapy, as a comparison between the effects of iron and placebo could not be made for the individual subject.According to multivariate analysis, determination of serum ferritin concentration was the most valuable indirect method for the diagnosis of depleted iron stores, and we are of the opinion that serum ferritin determination may replace bone marrow examination in the diagnosis of iron deficiency in women with or without anaemia who are otherwise healthy.

Evaluation of sternal bone marrow aspiration for detection of tumor cells in patients with bronchogenic carcinoma

We evaluated sternal bone marrow aspiration as a routine pretreatment procedure in patients with bronchogenic carcinoma. The overall rate of identification of tumor cells by this technique was found to be low. When oat cell bronchogenic carcinoma was considered as a separate entity, the positive rate was higher. However, in no instance did the bone marrow aspiration result in a change in clinical staging.