Janssens A M, Offner F C, Van Hove W Z
University Hospital Ghent, Department of Hematology, Ghent, Belgium.
Cancer. 2000 Apr 15;88(8):1769-80.
In the medical community, little is known regarding bone marrow necrosis (BMN) as a clinicopathologic entity, although to the authors' knowledge it was described for the first time more than 50 years ago. To identify the rate of prevalence, the symptoms and signs, the underlying disease associations, and the usefulness of diagnostic procedures, an extensive literature search was made.
Only cases identified as extensive necrosis and diagnosed during life were selected. Two hundred forty cases met these criteria.
Bone pain (75%) and fever (68.5%) were the most important symptoms, whereas anemia (91%) and thrombocytopenia (78%), associated with a leukoerythroblastic picture (51%), were the most frequent hematologic abnormalities. Nearly 50% of patients showed elevated lactate dehydrogenase and alkaline phosphatase levels. In 90% of the patients an underlying malignancy was identified.
Bone marrow necrosis is caused by hypoxemia after failure of the microcirculation. Given the high rate of malignancy as an underlying disease association, an extensive search for neoplastic disease is justified whenever BMN is diagnosed. Pancytopenia and embolic processes are major complications that should be managed with supportive measures until effective treatment of the underlying disease has been administered. When necrosis resolves, repopulation of the bone marrow cavity with normal hematopoiesis is observed.
在医学界，尽管据作者所知骨髓坏死（BMN）在50多年前就首次被描述，但作为一种临床病理实体，人们对它知之甚少。为了确定其患病率、症状和体征、潜在疾病关联以及诊断程序的实用性，我们进行了广泛的文献检索。
仅选择那些被确定为广泛性坏死且在生前确诊的病例。有240例符合这些标准。
骨痛（75%）和发热（68.5%）是最重要的症状，而贫血（91%）和血小板减少（78%），伴有幼稚粒-幼红细胞血象（51%），是最常见的血液学异常。近50%的患者乳酸脱氢酶和碱性磷酸酶水平升高。90%的患者被发现有潜在的恶性肿瘤。
骨髓坏死是微循环衰竭后低氧血症所致。鉴于作为潜在疾病关联的恶性肿瘤发生率很高，每当诊断出BMN时，对肿瘤性疾病进行广泛检查是合理的。全血细胞减少和栓塞过程是主要并发症，在对潜在疾病进行有效治疗之前，应采取支持措施进行处理。当坏死消退时，可观察到骨髓腔被正常造血重新填充。
