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Year : 2015  |  Volume : 58  |  Issue : 2  |  Page : 252
Bicytopenia secondary to systemic oxalosis


1 Department of General Medicine, MES Medical College, Perintalmanna, Kerala, India
2 Department of Pathology, MES Medical College, Perintalmanna, Kerala, India
3 Muslim Educational Society, MES Medical College, Perintalmanna, Kerala, India

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Date of Web Publication17-Apr-2015
 

How to cite this article:
Abdulla MC, Alungal J, Siddik A, Musambil M. Bicytopenia secondary to systemic oxalosis. Indian J Pathol Microbiol 2015;58:252

How to cite this URL:
Abdulla MC, Alungal J, Siddik A, Musambil M. Bicytopenia secondary to systemic oxalosis. Indian J Pathol Microbiol [serial online] 2015 [cited 2019 Dec 9];58:252. Available from: http://www.ijpmonline.org/text.asp?2015/58/2/252/155337


A 31-year-old male born of a second degree consanguineous union was admitted with fatigue for 3 months. His past medical history was significant for recurrent renal stones from the age of 12 years. He was evaluated and diagnosed to have primary hyperoxaluria. He developed renal failure secondary to nephrolithiasis and is on hemodialysis for past 6 years. His younger brother also has renal failure secondary to nephrolithiasis. Examination showed hepatosplenomegaly. His hemoglobin was 8.9 g/dl (normocytic, normochromic), total white blood cell count 4900/µl, platelet count 1.1 10 9 /L, erythrocyte sedimentation rate 88 mm in 1 h. Peripheral smear showed dimorphic anemia, anisopoikilocytosis, polychromasia and mild thrombocytopenia. He had normal blood sugars and altered renal function tests. Liver function tests showed only hypoalbuminemia. A bone marrow biopsy revealed extensive eosinophilic needle shaped crystalline structures arranged in radial pattern replacing normal hematopoietic cells [Figure 1]a and b, which showed birefringence under polarized light [Figure 1]c and d consistent with calcium oxalate monohydrate crystals.
Figure 1: Bone marrow showing extensive eosinophilic needle shaped crystalline structures arranged in radial pattern replacing normal hemopoietic cells with H and E, staining (a and b) which showed positive birefringence under polarized light (c and d)


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Primary hyperoxaluria is an inherited disorder featured by the hyperoxaluria, calcium oxalate urinary lithiasis in childhood, nephrocalcinosis, and renal failure. Bone marrow oxalate deposition can be associated with variable degrees of cytopenias, leukoerythroblastic picture, and hepatosplenomegaly. [1],[2] Bone marrow aspirate may be unsuccessful due to extensive crystal deposition or accompanying fibrosis. Mechanical obliteration of bone marrow by calcium oxalate crystals may lead to pancytopenia and hepatosplenomegaly as late complications in oxalosis. We report a case of the bonemarrow involvement in oxalosis presenting as bicytopenia.

 
   References Top

1.
Bakshi NA, Al-Zahrani H. Bone marrow oxalosis. Blood 2012;120:8.  Back to cited text no. 1
    
2.
Halil O, Farringdon K. Oxalosis: An unusual cause of leucoerythroblastic anaemia. Br J Haematol 2003;122:2.  Back to cited text no. 2
    

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Correspondence Address:
Dr. Mansoor C Abdulla
Department of General Medicine, MES Medical College, Perintalmanna - 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.155337

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