Hemogram and bone marrow morphology in children with chronic ...

World Journal of PediatricsTable 3. Dyshematopoiesis of bone marrow in the CAA and MDS groupsGroupnMicromegakaryocyte(%)Single-round-nucleusmegakaryocyte (%)Multi-round-nucleusmegakaryocyte (%)Pelger-Huet Megaloblastic changes inabnormality (%) granulocytic lineage (%)CAA 31 0 0 0 0 0 0MDS 17 94.1 29.4 64.7 17.6 47.0 88.29430 bpMegaloblastic changes inerythrocytic lineage (%)Original articleTable 4. Bone marrow biopsy results in the CAA and MDS groupsGroupnStage of proliferationHypercellularity Normal cellularity Hypocellularity Extreme hypocellularityCAA 31 0/31 1/31 23/31 7/31HemotopoietictissueObviousreductionAdiposetissueObviousinductionMDS 17 2/17 10/17 5/17 0 Normal range Normal range 17/17Table 5. Bone marrow biopsy results in the CAA and MDS groupsGroupnErythroblasts in thesame developing stageALIPProliferation offibrin tissueMicromegakaryocyteSingle-round-nucleusmegakaryocyteCAA 31 0 0 5/31 0 0 0MDS 17 7/17 15/17 17/17 17/17 9/17 13/17ALIP: abnormal localization of immature precursors.Existence ofmegakaryocyte3/31Multi-round-nucleusmegakaryocyte38Fig. 1. Bone marrow smear in the CAA group showing hypocellularityand normal morphology (Wright, 10×100).Fig. 2. Dyshematopoiesis in the MDS group shown by bone marrowsmear. Arrow: erythroblasts dysplasia; arrowhead: Pegler-Hunt(Wright, 10×100).Fig. 3. Bone marrow biopsy in the CAA group showing hypocelluarityand normal morphology (HGE, 10×40).Fig. 4. MDS in bone marrow biopsy. Arrow: abnormal localization ofimmature precursors; arrowhead: single-round-nucleus megakaryocytes(HGE, 10×40).World J Pediatr, Vol 4 No 1 . February 15, 2008 . www.wjpch.com

Chronic aplastic anemia and myelodysplastic syndromeBone marrow smear in CAA and MDS patientsBone marrow of the MDS patients showed activeor marked proliferation. The counts of myeloblasts,promyelocytes, proerythroblasts, basophilic erythroblastsand megakaryocytes in the bone marrow of theMDS patients were significantly higher than thoseof the CAA patients, and the count of lymphocyteswas lower than that in the CAA patients (P

World Journal of PediatricsOriginal article40children. Bone marrow biopsy for MDS can revealinsignificant deficiency of hemotopoietic tissue [7]incontrast to fibrin tissue because of the productionof megakaryocytes with no function. [25]Abnormalmegakaryocytes, ALIP and dyshematopoiesis arethe features of MDS. [26]Erythroblast islets in thebone marrow of MDS and CAA patients in the samedeveloping stage have not been reported so far.Various clinical features of CAA and MDS are perhapsbased on different changes of molecular biology, buthemogram, bone marrow smear and biopsy are alwaysessential to the diagnosis of blood diseases.Funding: None.Ethical approval: Not needed.Competing interest: No benefits in any form have been receivedor will be received from a commercial party related directly orindirectly to the subject of this article.Contributors: Wen JQ proposed the study and wrote the firstdraft. Feng HL analyzed the data. All authors contributed to thedesign and interpretation of the study and to further drafts. WangXQ is the guarantor.References1 Yang CL. Aplastic anemia, 2nd ed. Tianjin: TianjinTechnology Translating Publishing Corporation, 2000: 1-2.2 Gewirtz AM, Hoffman R. Current considerations of theetiology of aplastic anemia. Crit Rev Oncol Hematal1985;4:1-30.3 Aggio MC, Alvarez RV, Bartomioli MA, Maguitman O.Incidence and etiology of aplastic anemia in a definedpopulation of Argentina (1966-1977). Medicina (B Aires)1988;48:231-233.4 Marti J, Garcia-Martin C. Aplastic anemia caused bycarbamazepine. Neurologia 1989;4:221-222.5 Bessho F, Imashuku SH, Tsuchida M, Nakata T, Mivazaki S.Serial morphologic observation of bone marrow in aplasticanemia in children. Int J Hematol 2005;81:400-404.6 Majumder D, Banerjee D, Chandra S, Banerjee S,Chakerabarti A. Red cell morphology in leukemia, hypoplasticanemia and myelodysplastic syndrome. Pathophysiology2006;13:217-225.7 Das R, Hayer J, Dey P, Garewal G. 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Xi'an: Xi'an The World PublishingCorporation, 1998: 238-247, 257-266.24 Wu MY, Huang SL. Modern Pediatric Hematology. Fuzhou:Fujian Science & Technology Publishing Corporation, 2003:432-442.25 Shen ZX, OuYang RR. Hematology Oncology. Beijing:People's Medical Publishing House, 1999: 482.26 Pu Q. Color atlas of histopathology in hematology. Tianjin:Tianjin Technology Publishing Corporation, 1990: 67.Received July 25, 2006Accepted after revision October 12, 2007World J Pediatr, Vol 4 No 1 . February 15, 2008 . www.wjpch.com