6 DISEASES OF THE BONE MARROW AND THEIR CHARACTERISTICS - NEUROPSYCHOLOGY - 2025

The diseases of the bone marrow occur because there is a problem in one of the cell types described. The causes of these problems are diverse in nature and include both genetic and environmental factors. For example, in leukemia the white blood cells do not work well.

To check for any type of bone marrow disease, tests are usually performed on both blood and the marrow itself. Treatment depends on the type of disease and its severity, but ranges from medications to blood transfusions or bone marrow transplantation.

Bone marrow

Bone marrow is a spongy tissue found inside some of the bones, such as those in the hip or thigh. This tissue contains stem cells that can develop into any type of blood cell.

Stem cells created by the marrow turn into red blood cells that carry oxygen; in white blood cells that are part of the immune system and act against infections; and in platelets that serve to plug wounds by clotting the blood.

Most common diseases of the bone marrow

- Leukemia

Wright-stained bone marrow aspiration specimen from a patient with acute lymphoblastic leukemia. Source: The original uploader was VashiDonsk at English Wikipedia.

Leukemia is a type of cancer that occurs in the white blood cells, which is why it is also known as white blood cell cancer. As in all cancers, the disease occurs because too many cells are created in an uncontrolled way.

White blood cells, which can be granulocytes or lymphocytes, develop in the bone marrow from stem cells. The problem that occurs in leukemia is that stem cells are not able to mature into white blood cells, they stay in an intermediate step called leukemia cells.

Leukemic cells do not degenerate, so they continue to grow and multiply uncontrollably, occupying the space of red blood cells and platelets. Therefore, these cells do not perform the function of white blood cells and, in addition, prevent the proper functioning of the rest of the blood cells.

Symptoms

The main symptoms suffered by patients with leukemia are bruising and / or bleeding with any blow and the continuous feeling of being tired or weak.

In addition, they may suffer the following symptoms:

• Difficulty breathing.
• Pallor.
• Petechiae (flat spots under the skin caused by bleeding).
• Pain or a feeling of fullness under the ribs on the left side.

The prognosis of this disease is better the fewer stem cells have been transformed into leukemic cells, therefore, it is very important to see a doctor if you feel some of the symptoms to make an early diagnosis.

Treatment

Treatment depends on the type of leukemia, the age, and the characteristics of the patient. Possible treatments include the following:

• Chemotherapy.
• Targeted therapy (molecularly).
• Radiotherapy.
• Stem cell or bone marrow transplant.

- Myelodysplastic syndromes

Dysplastic megakaryocytes in the marrow of a patient with myelodysplastic disorder. Source: Ed Uthman from Houston, TX, USA

Myelodysplastic syndromes (MDS) include a number of diseases that affect the bone marrow and blood. The main problem with these syndromes is that the bone marrow produces fewer and fewer blood cells, even stopping production altogether.

Patients who suffer from MDS can suffer from:

• Anemia, due to low levels of red blood cells.
• Infections, as they increase the odds due to low levels of white blood cells.
• Bleeding, due to low platelet levels.

There are several types of MDS, some are mild and can be easily treated, while others are serious and can even progress to a leukemia called acute myelogenous leukemia.

Most of the people who suffer from this disease are over 60 years old, although it can appear at any age. Some factors can increase the probability of developing this disease, such as exposure to industrial chemicals or radiation. In some cases, MDS is caused by chemotherapy treatment that the person was taking to treat another disease.

Symptoms

Symptoms depend on the severity of the disease. It is usual that at the beginning of the disease no symptoms are felt and, nevertheless, the disease is diagnosed because problems are found in a routine analysis. That is why it is very important to get regular check-ups.

The general symptoms are similar to those of leukemia and include tiredness, shortness of breath, paleness, easy to get infections and to bleed…

Treatment

Treatment usually begins with drugs and chemotherapy, although in many cases a blood transfusion or bone marrow transplant is necessary.

- Myeloproliferative disorders

Myelogram of a patient with a myeloproliferative disorder. Source: Elm'hadi C1,2, Khmamouche MR3, Tanz R3, Toreis M3, Mahtat E4, Allaoui M5, Oukabli M5, Messaoudi N6, Errihani H7, Ichou M3.

Myeloproliferative disorders are a heterogeneous group of diseases characterized by the excessive production of one or more types of blood cells (red, white blood cells, or platelets).

Patients with these types of disorders are more likely to suffer thrombi and bleeding. Also, they may end up developing acute leukemia due to both the underlying disease and the treatment.

Symptoms

The symptoms and signs that patients with these disorders may suffer are the following:

• Tiredness and weakness
• Weight loss, early satiety, or even anorexia, especially if they suffer from chronic myelogenous leukemia or agnogenic myeloid metaplasia.
• Easy bruising, bleeding, or thrombus.
• Joint pain and inflammation
• Priapism, tinnitus or stupor of leukostasis.
• Petechiae and / or schimosis (purple coloration).
• Palpable spleen and / or liver.
• Acute febrile neutrophilic dermatosis or Sweet's syndrome (fever and painful lesions on the trunk, arms, legs, and face).

- Aplastic anemia

Left hand of patient with anemia, right person without anemia. Source: James Heilman, MD

Aplastic anemia is a rare blood disease that can be very dangerous. This disease is characterized by the fact that the bone marrow of people with aplastic anemia is unable to produce enough blood cells.

This disease occurs because the stem cells of the bone marrow are damaged. There are several factors that can affect stem cells, and these conditions can be both hereditary and acquired, although in many cases it is not known what the cause is.

Among the acquired causes we can find the following:

• Poisoning with substances such as pesticides, arsenic, or benzene.
• Receive radiation therapy or chemotherapy.
• Taking certain medications.
• Having some infections such as hepatitis, Epstein-Barr virus, or HIV.
• Suffering from an autoimmune disease.
• Be pregnant.

Symptoms

This disorder is progressive, therefore, the symptoms get worse as time passes.

Early in the disease, people diagnosed with aplastic anemia experience symptoms such as tiredness, weakness, dizziness, and breathing difficulties. In more severe cases they can have heart problems such as arrhythmia or heart failure. In addition, they can suffer frequent infections and bleeding.

The diagnosis of this disease is established based on the personal and family history of the person, a medical examination and some medical tests such as blood tests.

Treatment

Treatment should be individualized for the person, but in general, it usually includes blood transfusions, bone marrow transplants and / or medicines.

- Iron deficiency anemia

Iron deficiency anemia rub. Source: Rjgalindo

Iron deficiency anemia occurs when the levels of red blood cells are very low or not working well. This type of anemia is the most common and is characterized by the fact that the cells of our body do not receive enough iron through the blood.

The body uses iron to make hemoglobin, a protein that is responsible for transporting oxygen through the bloodstream. Without this protein, the organs and muscles do not receive enough oxygen, which prevents them from burning nutrients for energy and, therefore, cannot function efficiently. In short, the lack of iron in the blood causes the muscles and organs to not work properly.

Symptoms

Many people with anemia don't even realize they have any problems. Women are at higher risk for this type of anemia due to blood loss during menstruation or pregnancy.

This disease can also occur because the person does not get enough iron in their diet or due to some intestinal diseases that cause problems absorbing iron.

Treatment

Treatment depends on why the anemia was caused, but usually includes a change in diet and iron supplements.

- Plasma cell neoplasia

Histopathological image of multiple myeloma in bone marrow, stained with hematoxylin and esoin. Source: No machine-readable author provided. KGH assumed (based on copyright claims).

Plasma cell neoplasms are diseases characterized by the fact that the bone marrow makes too many cells of this type. Plasma cells develop from B lymphocytes, which in turn have matured from stem cells.

When some external agents (such as viruses or bacteria) enter our body, lymphocytes usually become plasma cells, since these create antibodies to fight infection.

The problem for people who suffer from any of these disorders is that their plasma cells are damaged and divide in an uncontrolled way, these damaged plasma cells are called myeloma cells.

In addition, myeloma cells give rise to a protein that is useless for the body, since it does not act against infections, the M protein. The high density of these proteins causes the blood to thicken. In addition, as they are useless, our body is continually discarding them, so they can cause kidney problems.

The continuous reproduction of plasma cells causes tumors to be created, which can be benign or can develop into cancer.

Neoplasms include the following conditions:

Monoclonal gammopathy of uncertain significance (MGUS)

This pathology is mild, since the abnormal cells represent less than 10% of the blood cells and do not usually develop cancer. In most cases, patients do not notice any type of signs or symptoms. Although there are more serious cases in which they can suffer nerve, heart or kidney problems.

Plasmacytoma

In this disease, abnormal cells (myelomas) are stored in the same place, creating a single tumor called a plasmacytoma. There are two types of plasmacytomas:

• Bone plasmacytoma. In this type of plasmacytoma, as the name suggests, the tumor is created around a bone. Patients do not usually notice symptoms other than those due to the tumor itself, such as brittle bones and localized pain, although it can sometimes worsen over time and multiple myeloma may develop.
• Extramedullary plasmacytoma. In this case, the tumor is not located in a bone, but in some soft tissue such as that of the throat, the tonsil or the paranasal sinuses. The symptoms suffered by patients with this type of plasmacytoma depend on the exact place where the tumor is located. For example, a plasmacytoma in the throat can cause swallowing difficulties.

Multiple myeloma

This is the most serious type of neoplasm, since the uncontrolled production of myelomas produces multiple tumors that can affect the bone marrow, causing it to produce fewer blood cells (red blood cells, white blood cells or platelets).

On some occasions, no symptoms are felt at the beginning of the disease, so it is highly recommended to perform blood and urine tests periodically and see a doctor if you suffer any of these symptoms:

• Pain located in the bones.
• Bone fragility.
• Fever without a known cause or frequent infections.
• Presence of bruising and bleeding easily.
• Trouble breathing
• Limb weakness.
• Feeling of extreme and continuous tiredness.

If tumors occur in the bones they can cause hypercalcemia, that is, too much calcium in the blood. This condition can cause serious problems such as loss of appetite, nausea and vomiting, thirst, frequent urination, constipation, tiredness, muscle weakness, and confusion or trouble concentrating.

References

1. bethematch.com. (sf). Myelodysplastic syndromes (MDS). Retrieved on May 30, 2016, from bethematch.com.
2. (sf). Bone Marrow Diseases. Retrieved on May 30, 2016, from MedlinePlus.
3. National Cancer Institute. (September of 2013). What You Need To Know About Leukemia. Obtained from NIH.
4. National Cancer Institute. (August 2015). Myelodysplastic / Myeloproliferative Neoplasms Treatment (PDQ®) –Patient Version. Obtained from NIH.
5. National Cancer Institute. (October 1, 2015). Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®) –Patient Version. Obtained from NIH.
6. National Heart, Lung and Blood Institute. (August 22, 2012). What Is Aplastic Anemia? Obtained from NIH.
7. National Heart, Lung and Blood Institute. (March 26, 2014). What Is Iron-Deficiency Anemia? Obtained from NIH.
8. Rasool, H., Talavera, F., & Besa, E. (February 26, 2016). Myeloproliferative Disease. Obtained from Medscape.