S. Bulvik et al., EXTENSIVE BONE-MARROW NECROSIS ASSOCIATED WITH ANTIPHOSPHOLIPID ANTIBODIES, The American journal of medicine, 98(6), 1995, pp. 572-574
Bone marrow necrosis (BMN), defined morphologically by destruction of
hematopoietic tissue, including the stroma, with preservation of the b
one, is a rare syndrome. The conditions in which it is seen include si
ckle cell disease, acute leukemia, metastatic neoplasia, and bacterial
infection, particularly when hypovolemia and septic shock are present
. BMN is also associated with disseminated intravascular coagulation (
DIC) following irradiation and antineoplastic therapy. The antiphospol
ipid syndrome (APS) is characterized by antibodies directed against th
e antiphospolipid substrate. Because this substrate is prominently inv
olved in the coagulation cascade and widely distributed on cell walls,
patients present with venous or arterial thromboses, recurrent aborti
on, thrombocytopenia, and Coombs' positive hemolytic anemia, typically
with raised anticardiolipin antibodies or a diagnostic lupus anticoag
ulant test. BMN does not appear to have been previously recognized in
this context. We report what we believe to be the first such case and
suggest that the high titers of antibodies present may have played a c
entral role in its pathogenesis.