Xu Min, Chisholm Karen M, Fan Guang, Stevens Anne M, Rutledge Joe C
1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.
2 Department of Laboratory Medicine, University of Washington, Seattle, Washington.
Pediatr Dev Pathol. 2018 May-Jun;21(3):300-307. doi: 10.1177/1093526617734948. Epub 2017 Oct 9.
In our recent case report, the finding of lupus erythematosus (LE) cells in a bone marrow aspirate led to the diagnosis of systemic lupus erythematosus (SLE) and appropriate treatment, although the patient was not clinically suspected to have SLE. To determine whether LE cells are present in the bone marrow aspirates of SLE patients, but overlooked in routine bone marrow morphology review, bone marrow aspirates from 30 pediatric patients (15 with SLE and 15 with other diagnoses) evaluated by rheumatologists were reviewed. LE cells were found in the bone marrow aspirates of only 1 SLE patient and none in non-SLE patients. However, hematoxylin bodies were identified in 53% (8/15) of SLE patients. Neither hematoxylin bodies nor LE cells were found in the aspirates from patients with other disorders. Three additional pediatric patients identified prospectively were found to have hematoxylin bodies in the bone marrow aspirates. Although the diagnosis was not initially suspected, 2 of the 3 patients were subsequently diagnosed with SLE. All patients with hematoxylin bodies and SLE had antinuclear antibody titers ≥1:640 with a homogeneous staining pattern. In addition, bone marrow aspirates of 9 adult patients were reviewed, and neither LE cells nor hematoxylin bodies were identified. In summary, hematoxylin bodies were present in the bone marrow aspirates of many pediatric SLE patients, while LE cells were rare. The finding of hematoxylin bodies in pediatric bone marrow aspirates is a helpful and specific diagnostic clue that may lead to the diagnosis of SLE when other clinical features are nonspecific.
在我们最近的病例报告中，尽管患者临床上未被怀疑患有系统性红斑狼疮（SLE），但在骨髓穿刺物中发现狼疮（LE）细胞后确诊为SLE并进行了适当治疗。为了确定LE细胞是否存在于SLE患者的骨髓穿刺物中，却在常规骨髓形态学检查中被忽视，我们对30例儿科患者（15例SLE患者和15例其他诊断患者）的骨髓穿刺物进行了复查，这些穿刺物由风湿病学家进行评估。仅在1例SLE患者的骨髓穿刺物中发现了LE细胞，非SLE患者中未发现。然而，在53%（8/15）的SLE患者中发现了苏木精小体。其他疾病患者的穿刺物中未发现苏木精小体和LE细胞。另外前瞻性确定的3例儿科患者的骨髓穿刺物中也发现了苏木精小体。尽管最初未怀疑有该诊断，但其中2例患者随后被诊断为SLE。所有有苏木精小体且患有SLE的患者抗核抗体滴度≥1:640，呈均质染色模式。此外，我们复查了9例成年患者的骨髓穿刺物，未发现LE细胞和苏木精小体。总之，许多儿科SLE患者的骨髓穿刺物中存在苏木精小体，而LE细胞罕见。儿科骨髓穿刺物中发现苏木精小体是一个有用且特异的诊断线索，当其他临床特征不具特异性时，可能有助于SLE的诊断。
