Diagnosis of systemic lupus erythematosus from a bone marrow aspirate

✍ Scribed by Abbas Hashim Abdulsalam; Nafila Sabeeh; Abdulsalam Hatim; Barbara J. Bain

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 79 KB
• Volume: 87
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.22174

✦ Synopsis

An 18-year-old Iraqi girl presented with fever and a generalized rash. The spleen was palpable four cm below the left costal margin. A full blood count showed: white cell count 3 3 10 9 /l, hemoglobin concentration 97 g/l, platelet count 63 3 10 9 /l, neutrophil count 2.2 3 10 9 /l and lymphocyte count 0.6 3 10 9 /l. A bone marrow aspirate performed to investigate the thrombocytopenia showed a normocellular marrow with normal numbers of megakaryocytes. In addition numerous LE cells were detected (left image). The LE cells were detected in bone marrow films spread immediately without any anticoagulation, incubation or other manipulation. The diagnosis of systemic lupus erythematosus (SLE) was confirmed by the demonstration of antinuclear antibody and anti-double stranded DNA antibody.

An LE cell is a neutrophil that has ingested denatured nuclear material of another cell as the result of antinuclear activity in the plasma. This phenomenon was first described in the bone marrow in 1948 with a Feulgen stain being used to demonstrate that the ingested material was DNA [1]. In the subsequent year an in vitro test was reported using either buffy coat cells or normal bone marrow components plus the patient's plasma . Hargraves and colleagues [1] also described the phenomenon shown in the right image -''numerous mature polymorphonuclear leukocytes attempting to pick up the same mass of material''. With the availability of serological tests an LE cell preparation is now rarely used for the diagnosis of SLE. However the observation of LE cells in a bone marrow aspirate can still provide confirmation of this diagnosis.