BERKELEY, CA (UroToday.com) - Extramedullary haematopoiesis (EMH) is essentially a compensatory response to longstanding hypoxia as a result of chronic anaemia. It is intended to closely mimic a normal bone marrow. It is more common in patients not yet transfused, and in those with minor thalassemias (incidence of about 20%) or thalassemia intermedia, as opposed to thalassemia major, where the incidence is quoted to be less than 1%.
Apart from the thoracic spine, EMH is frequently seen in hepatosplenic areas which can potentially produce fetal haemoglobin. Non-hepatosplenic EMH has been reported in numerous sites, including lungs, gastrointestinal tract, urinary tract, adrenal glands, prostate, peritoneum, skin, breast, and central nervous system and paravertebral areas.
Most EMH is asymptomatic and is discovered incidentally. Specific treatment may not be required unless accompanied by symptoms. Treatment options for EMH depend on the location and mass effect symptom and include surgery, radiation, blood transfusion, and hydroxyurea or various combinations.
The importance of recognizing the adrenal as a site for EMH is in avoiding adrenalectomy, in those with an “incidentaloma,” when a biopsy could suffice, obviating the need for surgery.
John Samuel Banerji, MCh(Urology), DNB(Urology), MS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Christian Medical College, Vellore, India