Serous atrophy of bone marrow is a non-neoplastic bone marrow disorder that occurs with chronic illness and poor nutritional status. It is characterized by atrophy of the fatty marrow and loss of hematopoietic cells, replaced by an accumulation of extracellular mucinous substances(1)
Serous fat atrophy (gelatinous bone marrow transformation) is a rare condition that presents with weight loss and anemia.(2)
It is also termed gelatinous marrow transformation. The alternate diagnostic terms ‘starvation marrow’ or ‘serous atrophy of fat is used interchangeably.(3)
Gelatinous transformation of bone marrow (GTBM) was recognized in the 20th century in the autopsy specimens of patients with prolonged starvation and cachexia
GTBM is associated with numerous etiologies(4)
GMT is not a specific disease of bone marrow, but is like a symptom seen in some of the patients with severe/chronic illness
GMT has been most commonly reported in cases of malnutrition secondary to anorexia nervosa and starvation.
Cause: GMT may be a result of bioregulatory process (which presently needs further prospective studies) that are activated in different pathologic conditions; but resulting in similar lesion in the bone marrow and so till then it may be concluded that GMT is a symptom of bone marrow.
GMT has also been reported to be associated with malignancies
It has been suggested that some malignant cells might produce or stimulate the production of hyaluronic acid leading to gelatinous transformation. (5)
Although the pathogenesis is unknown, serous fat atrophy has been associated with acute febrile states, AIDS, alcoholism, anorexia nervosa, cachexia, carcinomas, chronic heart failure, and lymphoma.
The central physio pathological aspect of this condition is the depletion of fat cells due to a state of severe catabolism, with the subsequent deposition of a gelatinous substance on the bone marrow, which is mainly comprised of a hyaluronic acid-like material. This deposit renders the bone marrow as an adverse microenvironment for hematopoiesis.
Association of GMT with chronic mal/undernutrition suggested that the gelatinous transformation of marrow is caused by excessive production of mucopolysaccharide of ground substance to compensate for the mobilization of marrow fat which may have occurred to meet the energy requirement.
Patients can develop osteoporosis and may present with insufficiency fractures.
Patient may also show muscle as well as generalized weakness
Therapeutic approaches vary based on age and level of care.
Treatment is primarily improvement of the patient’s state of malnutrition by nutritional support.
improvement of patient’s health condition was reversible with appropriate food intake. (6)
What do researchers say?
Based on the heterogenicity of associated clinical disorders, GTBM indicates severe illness and not a particular disease
gelatinous transformation of marrow can be associated with systemic lupus, and that its detection in lupus patients calls for an evaluation of nutritional status. (7)
GTBM in present series was also associated with neurological disorder like epilepsy, cardiovascular disorder like dilated cardiomyopathy and ventricular septal defect, purpura - idiopathic thrombocytopenic and Henoch Schoenlein, respiratory disorder like chronic obstructive airway disease and gout.
Treatment for GTBM is based on treating the underlying disease
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Sources
7. https://www.sciencedirect.com/science/article/abs/pii/S0031302516363577
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