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Despite the rarity of inherited bone marrow failure syndromes (IBMFS), they represent diseases for which the molecular pathogenesis may be elucidated.
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The study and presentation of the details of their molecular biology and biochemistry are warranted not only for appropriate diagnosis and management of afflicted patients but also because they lend clues to the normal physiology of the normal hematopoiesis and, in many cases, mechanisms of carcinogenesis.
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Several themes have emerged within each
The Inherited Bone Marrow Failure Syndromes
Section snippets
Key points
The ribosomopathies
In recent years, the subset of patients affected with Diamond-Blackfan anemia (DBA), Shwachman-Diamond-Bodian syndrome (SDBS), dyskeratosis congenita (DC), and cartilage hair hypoplasia (CHH) have all been shown to have mutations in ribosomal proteins and in proteins responsible for processing of ribosomal RNA.1 The reports of amelioration of a DBA-like phenotype in the p53-deficient mouse and zebrafish imply that defects in the ribosome assembly pathway and imbalances in protein synthesis lead
FA/BRCA pathway
FA is an autosomal and X-linked recessive disorder characterized by bone marrow failure, AML, solid tumors, and developmental abnormalities. At the molecular level, cells derived from patients with FA show hypersensitivity to DNA cross-linking agents, resulting in increased numbers of chromosomal abnormalities, including translocations and radial chromosomes. This hypersensitivity has made successful treatment of patients with FA a challenge in the past because traditional treatments of
Pearson Syndrome
Pearson syndrome is a rare sideroblastic anemia with associated exocrine pancreatic dysfunction, liver dysfunction, and renal tubule defects.125, 126 Often, patients are diagnosed in the neonatal period, and Pearson syndrome has been reported as a cause of hydrops. Rarely, these patients can have physical abnormalities such as retinopathy, ataxia, or muscle weakness but often present with failure to thrive or poor growth along with persistent, macrocytic anemia.127 These cases, numbering no
Reticular dysgenesis
This extremely rare disease almost exclusively presents in the neonatal period with leukopenia and lymphopenia and no myeloid and lymphoid precursors but usually not complete marrow aplasia.132, 133, 134, 135 Lymphoid tissue is generally absent. Early progenitors are probably the defective cells, because 2 distinct lineages are affected. However, a subset of patients has anemia and thrombocytopenia. Genetic analysis has shown that reticular dysgenesis (RD) is of mitochondrial origin, with
Amegakaryocytic Thrombocytopenia
A few cases with isolated thrombocytopenia have been reported in patients who show none of the classic findings of FA or thrombocytopenia/absent radii syndrome (TAR). These patients have a range of developmental defects, including microcephaly, low birth weight, delay, cardiac defects, central nervous system defects, and orthopedic anomalies. The presentation of most patients includes thrombocytopenia without megakaryocytes on marrow examination. Progressively, an increasingly hypocellular
Congenital dyserythropoietic anemia
The congenital dyserythropoietic anemias (CDAs) are a group of isolated red cell production disorders characterized by morphologic abnormalities of erythroid precursors in the bone marrow, a consequence of dyserythropoiesis and ineffective erythropoiesis.143, 144 In addition, distal limb malformations, including syndactyly, absence of phalanges and nails, an additional phalanx, and duplication or hypoplasia of the metatarsals, have been reported in several cases of CDA I.145 Other congenital
Workup of a patient with bone marrow failure
The clinical signs of pancytopenia include infection, bruising, and pallor. A blood count, usually performed by the primary care physician or emergency department, then shows pancytopenia. Sepsis or viral suppression can result in neutropenia and thrombocytopenia, and thus, the clinical situation must be considered any time one considers the diagnosis of hypoplastic marrow. In the absence of sepsis, a complete blood count and manual examination of the peripheral smear are mandatory. In
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Uncovering the Genetic Etiology of Inherited Bone Marrow Failure Syndromes Using a Custom-Designed Next-Generation Sequencing Panel
2024, Journal of Molecular DiagnosticsClonality in immune aplastic anemia: Mechanisms of immune escape or malignant transformation
2022, Seminars in HematologyCitation Excerpt :Aplastic anemia can be classified as either immune/acquired or inherited. Inherited bone marrow failure syndromes (IBMFS) result from germline (GL) mutations and are often identified at birth or in early childhood, but also less frequently later in life [2,3]. An increased risk of malignant transformation is reported with IBMFS, requiring life-long monitoring.
Bone Marrow Failure Syndromes
2018, Hematopathology: A Volume in the Series: Foundations in Diagnostic PathologyInherited Bone Marrow Failure Syndromes
2018, Hematology: Basic Principles and PracticeInherited Bone Marrow Failure Syndromes
2017, Hematology: Basic Principles and PracticeTreatment-related toxicities in children with acute lymphoblastic leukaemia predisposition syndromes
2016, European Journal of Medical GeneticsCitation Excerpt :Treatment modifications and intensified surveillance may be indicated depending on specific preexisting organ deficiencies. Furthermore, many patients with bone-marrow failure syndromes, including dyskeratosis congenital, are highly sensitive to radiation and alkylating agents (Chirnomas and Kupfer, 2013). These syndromes, including Wiskott-Aldrich syndrome and Brutons X-linked agammaglobulinemia, are know to be associated with an increased risk of lymphoma, whereas almost no cases of childhood ALL has been reported (Hoshino et al., 2015; Albert et al., 2011).