case_images: PMC11191611_01
case_images: Bone marrow pathology biopsies of patients at different times. (a) 2022/01. (b) 2022/05. (c). 2022/10. (d) 2023/03.
case_images: 10.1177_20406207241260353-fig1.jpg
case_images: PMC11191611_01_10.1177_20406207241260353-fig1.jpg
case_images: fig1-20406207241260353
case_images: The sternal bone marrow aspirate displayed a similar profile. The bone marrow biopsy revealed that haematopoietic tissue was made up of 35% without fibrosis, normal proliferation of granulocytic and erythroid lineages, no abnormal localization of immature precursors, erythroid 'islands' were seen, the number of megakaryocytes decreased without obviously dysplasia megakaryocytes and no small megakaryocytes were found in CD41 immunohistochemistry [Figure 1(a)]. Bone marrow biopsy showed that haematopoietic components were made up of about 5%, with a small proportion of myelocyte, metamyelocyte, erythroblasts and small lymphocyte, lobulated nuclei megakaryocytes were seen [Figure 1(b)]. After 9 months of treatment (October 2022) the blood cell count displayed that WBC 1.65 x 109/L, Hb 60 g/L, Plt 7 x 109/L, neutrophil (N) 32.1%, lymphocyte (L) 57.6%, mean corpuscular volume (MCV) 92.8 fl, RET 1.01%; the bone marrow biopsy showed that haematopoietic components were 5% and no megakaryocytes [Figure 1(c)], ferritin 1695 ng/mL. Bone marrow biopsy showed that haematopoietic components consisted of about 40% with normal myeloid and erythroid cell lineages, erythroid islands were seen, megakaryocytes count was nearly normal with lobulated nuclei predominantly [Figure 1(d)].
case_images: Changes in Hb and Plt after treatment with combined luspatercept and eltrombopag. (a:Hb;b:PLT).  , treatment with luspatercept; Hb, haemoglobin; Plt, platelet.
case_images: 10.1177_20406207241260353-fig2.jpg
case_images: PMC11191611_01_10.1177_20406207241260353-fig2.jpg
case_images: fig2-20406207241260353
case_images: Subsequently, luspatercept was discontinued and haemoglobin remained at normal levels in follow-up monitoring [Figure 2(a)]. After about 22 months of treatment (November 2023), the WBC was 6.5 x 109/L, Hb 141 g/L, Plt 131 x 109/L at the last follow-up [Figure 2(b)].