| Bone marrow necrosis is best defined as necrosis of myeloid tissue and medullary stroma in large areas of the hematopoietic bone marrow. The underlying diseases are variable. It was described for the first time as far as we know by Wase and Stevenson in 1942,in a patient with sickle cell disease who died of cerebral infarction. It was not until the early 1979s that BMN was frequently diagnosed before death. This was due to the rare character of its existence, and the sparse reporting in the hematologic literature. Bone marrow necrosis is a relatively uncommon clinnicapathologic entity. The etiology is diverse and malignancy, especially hematopoietic in origin, is the most common underlying disease of BMN.Now there is not good therapy for it and the prognosis is bad. Because the low prevalence and unobvious clinical manifestations, the occasion of wrong diagnosis and neglence of it is common. Recently, with the emergency of more and more durg, the BMN duing to the drugs become more. Doctors should notice this phenomenon.The goal of this article is to summarize the state of knowledge on BMN.Method: Retrospectively analyze the 60 cases of BMN diagnosed in our hospital from 1988-2003,and analyze its prevalence, the association with underlying diseases, and the usefulness of diagnostic procedures. Rusults: Between 1988 and 2003,BMN was diagnosed in 72 samples among 10700 BM trephine biopsies. The prevalence was found to be 0.67%.Every five years ,the prevalence is 1.4%,0.32%,0.62% respectively. The ages of the patients were between 17 and 78 years, and 33 of them were female. The ratio of male to female is 1:1.22.The time between the occurrence and diagnosis is 2 to 207 days. The average time is 40.2 days. There are 57 Malignancy cases, which are the most common underlying disease associations of the 60 cases. Hematologic malignancies were found in 40 records with ALL 14 cases, AML 8 cases, CML 9 cases, lymphoma 5 cases, and MM 4 cases. Solid tumor was found in 17 patients, including 4 stomach cancer cases, 5 lung cancer cases, 1 prostate case and 7 unspecific tumor cases. 47 cases are involved by infection. The most prominent symptoms of the patients were bone pain, which is seen in 83.3% of the cases, and it may be disseminated or localized in the lower back, including 63.6% in sternum 63.6%(35/55),pelvis58.2%(32/55),spine 47.3%(26/55),bilateral lower limbs70.9%(39/55).Usually strong anodyne was needed. Fever is seen in 85.0% cases, and the temperature usually was 37.5℃-39.0℃.Anemia is getting worse and worse, the average decrease of the Hb value is 4.6g/L.Hemarrhage is seen in 61.7% cases, and the manifestation includes purpa,petechia,gum hemorrhage ,nose hemorrhage ,increased volume menstruate and so on. The bleeding of viscera is uncommon。Bone pain and fever usually occur during the 2 days to 1 month of the occurrence of BMN. Hepatomegaly and splenomegaly are seen in 43.3%, 55.0% respectively. Anemia was in 56 cases(93.3%),WBC count may be normal,low,or elevated in 28.3%,40% and 37.1% of the cases, respectively. Thrombocytopenia is seen in 70% of the patients. Leukoerythroblastic blood findings are seen in 56.7% of the cases. Protein was found in 18 cases and hematuria was found in 9 cases in urine routine. Elevation in LDH and/or alkaline phosphatase as well as Ca and uric acid was common.6 patients had MRI examine. Three cases show T1 hypointense with T2 iso/hyperintense.1 case show T1 and T2 hyperintensity.2 cases show T1 hypointense and T2 hyperintense.4 patients had nuclide scanning and show the low bone marrow function. BM aspiration: Microscopically, there is amorphous eosinophilic material, and cells lose their normal staining characteristics. Gelatinous transformation and necrosis of the myeloid tissue, focal hypoplasia, and a background of amorphous eosinophilic material characterize Hisopathologically, BMN. BMN was graded semiquantitatively according to the extent of necrosis in the BM biopsy described by Maisel et al. Mild: <20%of the biopsy, Morderate-intermedi...
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