Bone Marrow Failure

Question 1

What are the signs and symptoms of Bone Marrow Failure?

Answer 1

Anaemia - Tiredness, Weakness, Pallor, Breathlessness, Tachycardia
Neutropenia - recurrent or severe bacterial infections.
Thrombocytopenia - easy bruising, petechiae, bleeding from the nose and/or gums.
Presence of hepatomegaly, splenomegaly or lymphadenopathy suggests a diagnosis of leukaemia.

Question 2

What are the signs pointing towards leukaemia?

Answer 2

Presence of hepatomegaly, splenomegaly and lymphadenopathy suggests a diagnosis of leukaemia.

Question 3

What condition presents with pancytopenia and hypocellular bone marrow?

Answer 3

Aplastic anaemia

Question 4

What are the common causes of aplastic anaemia?

Answer 4

Most cases are acquired and immune-mediated.

• Infection: EBV, HIV, parvovirus or mycobacteria
• Toxin exposure: Benzene
• Drugs: Sulphonamides
• Chemotherapy

Question 5

What is the cause of pancytopaenia with hypercellular bone marrow?

Answer 5

Bone marrow infiltration: Most commonly by cancerous cells:
Haematological infiltration:
- Acute leukaemia
- Myeloma
- myelofibrosis
- Myelodysplastic syndromes
- Infiltration with lymphoma

Non-haematological cancer:

• Breast, Thyroid, Kidney, Prostate, Lung cancers
• Melanoma

Question 6

How do patients with acute leukaemia presents?

Answer 6

Bone marrow failure - pancytopenia
General symptoms - Sweats, Weight loss, Anorexia, Flu-like symptoms
Tissue infiltration - CNS, Testes, Gums, Skin, Thymus, Nodes

Question 7

What is an iatrogenic cause of BM failure?

Answer 7

Bone marrow failure is a frequent side effects of radiotherapy and chemotherapy.

Question 8

What is the definition of febrile neutropenia?

Answer 8

Febrile neutropenia is defined as an oral temperature ≥38.5°C or two consecutive readings of ≥38.0°C for two hours and an absolute neutrophil count ≤0.5 x 10^9/L, or expected to fall below 0.5 x 10^9/L

Question 9

What is the normal neutrophil count?

Answer 9

2.5-7.5 x 10^9/L

Question 10

What is considered severe neutropenia?

Answer 10

When neutrophil count is <0.5 x 10^9/L

Question 11

What are the causes of BM failure?

Answer 11

1. (Acquired) Aplastic anaemia: From infection with EBV, HIV, etc. or after exposure to chemotherapy, or from drugs or toxins.
2. Maturation defects: B12 or folate deficiency
3. Differentiation defects: Myelodysplasia
4. BM infiltration: Multiple myeloma, Lymphoma, any other non-haematological carcinoma