Reactive hyperplasia: occurs commonly in a wide range of infections, autoimmune disorders including immune thrombocytopenias, haemolytic anaemia, and megaloblastic anaemia and as a non-specific response to systemic malignancy. A variation is the occurrence of reactive/benign lymphoid aggregates. These are non-paratrabecular and polyclonal.
Granulomatous inflammation: the causes and histological features are similar to granulomas that occur elsewhere in the body, e.g., tuberculosis, sarcoidosis, reaction to malignancy.
HIV and AIDS: The marrow can show specific features such as neoplastic infiltration, opportunistic infections, absent iron stores and Parvovirus-induced red cell aplasia.
Aplastic anaemia: is diagnosed when marrow cellularity is < 25% of normality for the age. It may be congenital or acquired from exposure to toxins, viral infections or drugs. There is marked reduction in erythroid, myeloid and megakaryocytic series and increase in fat, perivascular plasma cells and lymphocytes.
The trephine biopsy is useful in diagnosis of megaloblastic anaemia but the features can be mistaken for acute leukaemia, hence, correlation with aspirate findings is mandatory.
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