Bone Marrow Pressure in Leukemic and Non-Leukemic Patients

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Abstract
The sternal and iliac crest bone marrow pressures in 14 patients (pts.) with neoplastic diseases having normal marrows, and 10 pts. with leukemia were detd. by means of recording strain gauges attached to bone marrow needles. The press. were studied with the pts. at rest in supine position, during exaggerated breathing, coughing, Valsalva and Mueller maneuvers, changes of body position, and following the injns. of epinepherine. In non-leukemic pts. without marrow disease, the resting sternal press. were approx. atmospheric, ranging from -5/-6 mm. / Hg to 4/2 mm. Hg. The iliac crest marrows (i.c.m.) were always found to have positive press. ranging from 2/0 mm. Hg to 17/15 mm. Hg. Coughing and the Valsalva maneuvers produced marked elevations in intramedullary press. in both sternal (s.) and (i.c.m.). The Mueller maneuver was associated with the development of pronounced negative press. in the sternal site, with only slight effect on the i.c.m. During the inspiratory phase of exaggerated respirations, (resps.) distinct negative pressures were produced in the s.m. which returned to resting pressure in the expiratory phase of resp. Little effect was noted on the i.c.m. cavity during exaggerated breathing. The act of sitting up, standing, and squatting was associated with a moderate increase in press. in both marrow sites. The intraven. injn. of epinephrine produced a decrease in mean press. and marked diminution of pulse press. in both marrow sites. Sternal press. were noted to become completely negative, and resp. fluctuations were reflected upon the press. tracing, suggesting that a periodic decrease of the afferent arterial blood flow to the marrow had occurred. These physiologic studies support the interpretation that the intramedullary circulation is a passive one and that the marrow cavity is a semi-closed space whose press. is dependent upon the volume of blood within the cavity. Elevated marrow press. were found in most leukemic pts., especially in acute leukemia. These press. ranged as high as 60/40 mm. Hg in the sternum and 73/65 mm. Hg in the i.e., and indicate that leukemic marrow is associated with an increased vascularity. The significance of these physiol. findings in terms of the leukemic process in man is discussed.