Severe thrombocytopenia may produce petechiae or ecchymoses. Patients with severe neutropenia may become infected and present with fever. The bone marrow aspirate is usually a dry tap because myelofibrosis makes it difficult to aspirate blood from the marrow cavity. Biopsy usually will reveal the underlying infiltrative process. Clusters or islands of large anaplastic cancer cells that bear characteristics of their primary tumor often are seen.
Malignant lymphomas invade bone marrow and can cause a myelophthisic myelopathy.
In miliary tuberculosis, caseating granulomas demonstrate positive acid-fast organisms. Tuberculosis granulomas also reveal typical Langhans-type giant cells with multiple nuclei. Gaucher cells clog or infiltrate the bone marrow, spleen, and liver. This disorder is inherited. Family history is very important.