Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
Am J Hematol. 2010 Feb;85(2):106-10. doi: 10.1002/ajh.21600.
Patients with hepatitis C virus (HCV) infection develop a number of hematologic disorders, with benign and malignant B-cell proliferations being the most common. HCV-infected patients are also prone to developing peripheral cytopenias, the etiologies of which are multifactorial and include hypersplenism and/or antiviral medications. Some of these patients may undergo bone marrow biopsy but no study has systematically recorded the bone marrow findings in this patient group. Here, we report on the range of bone marrow findings in 47 adult HCV-infected patients. These patients, who lacked concurrent human immunodefiency virus (HIV) infection, most commonly presented for a bone marrow biopsy due to abnormal peripheral cell counts. The bone marrow biopsies displayed a range of findings. Dyserythropoiesis, present in 19% of the cases, was the most common finding. Patients with pancytopenia(n = 6), as defined by current World Health Organization standards, were the most likely to have bone marrow abnormalities; two pancytopenic patients had acute myeloid leukemia, and one patient had a primary myelodysplastic syndrome. There was no correlation in bone marrow findings and antiviral medications, MELD score, cirrhosis or splenomegaly, suggesting that the degree of bone marrow dysfunction is independent of stage of HCV. The results of this study suggest that bone marrow biopsy in HCV-infected patients, even those with features of hypersplenism and/or documented antiviral therapy, can be a valid test for hematologic evaluation, especially for patients with severe pancytopenia and/or sudden alterations in peripheral cell counts.
丙型肝炎病毒（HCV）感染患者会出现多种血液系统疾病，其中良性和恶性 B 细胞增殖最为常见。HCV 感染患者也容易发生外周血细胞减少症，其病因多因素，包括脾功能亢进和/或抗病毒药物。其中一些患者可能需要进行骨髓活检，但尚无研究系统地记录了该患者群体的骨髓发现。在这里，我们报告了 47 例成年 HCV 感染患者的骨髓发现范围。这些患者无同时感染人类免疫缺陷病毒（HIV），最常因外周细胞计数异常而进行骨髓活检。骨髓活检显示出一系列发现。病态造血存在于 19%的病例中，是最常见的发现。根据当前的世界卫生组织标准，全血细胞减少症（定义为同时存在白细胞、红细胞和血小板减少）的患者最有可能出现骨髓异常；6 例全血细胞减少症患者中，有 2 例患有急性髓系白血病，1 例患有原发性骨髓增生异常综合征。骨髓发现与抗病毒药物、MELD 评分、肝硬化或脾肿大之间没有相关性，这表明骨髓功能障碍的程度与 HCV 分期无关。本研究结果表明，即使是那些有脾功能亢进和/或有记录的抗病毒治疗特征的 HCV 感染患者，骨髓活检也可以作为血液学评估的有效检测手段，特别是对于那些有严重全血细胞减少症和/或外周细胞计数突然改变的患者。
