Bone Marrow Failure

Question 1

Describe the appearance of bone marrow in a 50 year old

Answer 1

50:50 cellularity:fat

Question 2

What does a bone marrow trephine show?

Answer 2

Cellularity - heterogeneous population of cells

Question 3

What does a bone marrow aspirate show?

Answer 3

Individual cells

Question 4

What is the lifespan of a platelet?

Answer 4

5-7 days

Question 5

What is the lifespan of a red cell?

Answer 5

120 days

Question 6

What is the average lifespan of myeloid white cells (neutrophils)?

Answer 6

24 hours

Question 7

Define bone marrow failure syndrome

Answer 7

A syndrome where there is no production OR ineffective production and therefore no release/reduced release of cells into the bloodstream

Question 8

What are the causes of bone marrow failure?

Answer 8

Nutrition - B12, folate
Infections - EBV, HBV, Hep C, Parvovirus especially post transplantation
Iatrogenic - drugs such as chemotherapy, cotrimoxazole, chloramphenicol.
Infiltration - by secondary tumours (breast, thyroid, prostate, kidney, lung), haematological malignancies such as myeloma
Radiation
Congenital

Question 9

What are the consequences of bone marrow failure?

Answer 9

Anaemia
Thrombocytopenia - bruising, petechiae
Neutropenia

Question 10

What investigations would you order to investigate pancytopenia?

Answer 10

Reticulocyte count
B12, folate
Infection screen
LFTs& U&Es
TFTs
Bone marrow assessment