Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting.

With bone marrow disease, there are problems with the stem cells or how they develop:

• In leukemia, a cancer of the blood, the bone marrow makes abnormal white blood cells
• In aplastic anemia, the bone marrow doesn't make red blood cells
• In myeloproliferative disorders, the bone marrow makes too many white blood cells
• Other diseases, such as lymphoma, can spread into the bone marrow and affect the production of blood cells

Causes of bone marrow diseases include genetics and environmental factors. Tests for bone marrow diseases include blood and bone marrow tests. Treatments depend on the disorder and how severe it is. They might involve medicines, blood transfusions or a bone marrow transplant.

Amyloidosis occurs when abnormal proteins called amyloids build up and form deposits. The deposits can collect in organs such as the kidney and heart. This can cause the organs to become stiff and unable to work the way they should.

There are three main types of amyloidosis:

• Primary - with no known cause
• Secondary - caused by another disease, including some types of cancer
• Familial - passed down through genes

Symptoms can vary, depending upon which organs are affected. Treatment depends on the type of amyloidosis you have. The goal is to help with symptoms and limit the production of proteins. If another disease is the cause, it needs to be treated.

Metabolism is the process your body uses to get or make energy from the food you eat. Food is made up of proteins, carbohydrates, and fats. Chemicals in your digestive system break the food parts down into sugars and acids, your body's fuel. Your body can use this fuel right away, or it can store the energy in your body tissues, such as your liver, muscles, and body fat.

A metabolic disorder occurs when abnormal chemical reactions in your body disrupt this process. When this happens, you might have too much of some substances or too little of other ones that you need to stay healthy. There are different groups of disorders. Some affect the breakdown of amino acids, carbohydrates, or lipids. Another group, mitochondrial diseases, affects the parts of the cells that produce the energy.

You can develop a metabolic disorder when some organs, such as your liver or pancreas, become diseased or do not function normally. Diabetes is an example.

If you have anemia, your blood does not carry enough oxygen to the rest of your body. The most common cause of anemia is not having enough iron. Your body needs iron to make hemoglobin. Hemoglobin is an iron-rich protein that gives the red color to blood. It carries oxygen from the lungs to the rest of the body.

Anemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction.

Conditions that may lead to anemia include

• Heavy periods
• Pregnancy
• Ulcers
• Colon polyps or colon cancer
• Inherited disorders
• A diet that does not have enough iron, folic acid or vitamin B12
• Blood disorders such as sickle cell anemia and thalassemia, or cancer
• Aplastic anemia, a condition that can be inherited or acquired
• G6PD deficiency, a metabolic disorder

Anemia can make you feel tired, cold, dizzy, and irritable. You may be short of breath or have a headache.

Your doctor will diagnose anemia with a physical exam and blood tests. Treatment depends on the kind of anemia you have.

Anemia is a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells. If you have anemia, your body does not get enough oxygen-rich blood. The lack of oxygen can make you feel tired or weak. You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. According to the Centers for Disease Control and Prevention, about 3 million people in the United States have anemia.

There are many types of anemia, including:

• Iron-deficiency anemia
• Vitamin B12-deficiency anemia
• Hemolytic anemia

Mild anemia is a common and treatable condition that can develop in anyone. It may come about suddenly or over time, and may be caused by your diet, medicines you take, or another medical condition. Anemia can also be chronic, meaning it lasts a long time and may never go away completely. Some types of anemia are inherited. The most common type of anemia is iron-deficiency anemia.

Some people are at a higher risk for anemia, including women during their menstrual periods and pregnancy. People who do not get enough iron or certain vitamins and people who take certain medicines or treatments are also at a higher risk.

Anemia may also be a sign of a more serious condition, such as bleeding in your stomach, inflammation from an infection, kidney disease, cancer, or autoimmune diseases. Your doctor will use your medical history, a physical exam, and test results to diagnose anemia.

Treatments for anemia depend on the type you have and how serious it is. For some types of mild to moderate anemia, you may need iron supplements, vitamins, or medicines that make your body produce more red blood cells. To prevent anemia in the future, your doctor may also suggest healthy eating changes.

Aplastic anemia is a rare but serious blood disorder. If you have it, your bone marrow doesn't make enough new blood cells. There are different types, including Fanconi anemia. Causes include:

• Toxic substances, such as pesticides, arsenic, and benzene
• Radiation therapy and chemotherapy for cancer
• Certain medicines
• Infections such as hepatitis, Epstein-Barr virus, or HIV
• Autoimmune disorders
• Certain inherited conditions
• Pregnancy

In many people, the cause is unknown.

Symptoms include fatigue, weakness, dizziness, and shortness of breath. It can cause heart problems such as an irregular heartbeat, an enlarged heart, and heart failure. You may also have frequent infections and bleeding.

Your doctor will diagnose aplastic anemia based on your medical and family histories, a physical exam, and test results. Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you. Treatments include blood transfusions, blood and marrow stem cell transplants, and medicines.

Aplastic anemia is a rare but serious blood disorder that occurs when your bone marrow cannot make enough new blood cells for your body to work normally.

Overview

Aplastic anemia occurs because of damage to stem cells inside bone marrow, which is the sponge-like tissue within your bones. Many diseases and conditions can damage the stem cells in bone marrow. As a result, the bone marrow makes fewer red blood cells, white blood cells, and platelets.

The most common cause of bone marrow damage is from your immune system attacking and destroying the stem cells in your bone marrow, which is a kind of autoimmune disorder. The genes you inherit from your parents, some medicines, and certain toxins in the environment may also cause aplastic anemia.

Aplastic anemia can develop suddenly or slowly, and it can be mild or severe. Signs and symptoms of aplastic anemia include fatigue, infections that last a long time, and easy bruising or bleeding. The low levels of blood cells also increase your risk for complications such as bleeding, leukemia, or other serious blood disorders. Without treatment, aplastic anemia can lead to serious medical conditions such as arrhythmia and heart failure. To diagnose aplastic anemia, your doctor will order tests to determine whether you have low numbers of cells in your bone marrow and blood.

Treatments may include medicines to suppress your immune system, blood transfusions, or a blood and bone marrow transplant. A blood and bone marrow transplant may cure the disorder in some people. Removing a known cause of aplastic anemia, such as exposure to a toxin, may also cure the condition. Because people who have aplastic anemia are more likely to develop blood disorders, your doctor will monitor your condition and screen you for blood disorders regularly. If you take medicine to suppress your immune system, you will also need to take steps to prevent infection and the flu, including taking medicine and getting vaccines such as an annual flu shot.

Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains immature cells, called stem cells. The stem cells can develop into red blood cells, which carry oxygen throughout the body, white blood cells, which fight infections, and platelets, which help the blood to clot.

A bone marrow transplant is a procedure that replaces a person's faulty bone marrow stem cells. Doctors use these transplants to treat people with certain diseases, such as

• Leukemia
• Severe blood diseases such as thalassemias, aplastic anemia, and sickle cell anemia
• Multiple myeloma
• Certain immune deficiency diseases

Before you have a transplant, you need to get high doses of chemotherapy and possibly radiation. This destroys the faulty stem cells in your bone marrow. It also suppresses your body's immune system so that it won't attack the new stem cells after the transplant.

In some cases, you can donate your own bone marrow stem cells in advance. The cells are saved and then used later on. Or you can get cells from a donor. The donor might be a family member or unrelated person.

Bone marrow transplantation has serious risks. Some complications can be life-threatening. But for some people, it is the best hope for a cure or a longer life.

A blood or bone marrow transplant replaces abnormal blood-forming stem cells with healthy cells.

Overview

When the healthy stem cells come from you, the procedure is called an autologous transplant. When the stem cells come from another person, called a donor, it is an allogeneic transplant. Blood or bone marrow transplants most commonly are used to treat blood cancers or other kinds of blood diseases that decrease the number of healthy blood cells in the body. These transplants also may be used to treat other disorders.

For allogeneic transplants, your doctor will try to find a donor whose blood cells are the best match for you. Your doctor will consider using cells from your close family members, from people who are not related to you and who have registered with the National Marrow Donor Program, or from publicly stored umbilical cord blood. Although it is best to find a donor who is an exact match to you, new transplant procedures are making it possible to use donors who are not an exact match.

Blood or bone marrow transplants are usually performed in a hospital. Often, you must stay in the hospital for one to two weeks before the transplant to prepare. During this time, you will have a narrow tube placed in one of your large veins. You may be given medicine to make you sleepy for this procedure. You also will receive special medicines and possibly radiation to destroy your abnormal stem cells and to weaken your immune system so that it won’t reject the donor cells after the transplant.

On the day of the transplant, you will be awake and may get medicine to relax you during the procedure. The stem cells will be given to you through the narrow tube in your vein. The stem cells will travel through your blood to your bone marrow, where they will begin making new healthy blood cells.

After the transplant, your doctor will check your blood counts every day to see if new blood cells have started to grow in your bone marrow. Depending on the type of transplant, you may be able to leave, but stay near the hospital, or you may need to remain in the hospital for weeks or months. The length of time will depend on how your immune system is recovering and whether or not the transplanted cells stay in your body. Before you leave the hospital, the doctors will give you detailed instructions that you must follow to prevent infection and other complications. Your doctor will keep monitoring your recovery, possibly for up to one year.

Although blood or bone marrow transplant is an effective treatment for some conditions, the procedure can cause early or late complications. The required medicines and radiation can cause nausea, vomiting, diarrhea, tiredness, mouth sores, skin rashes, hair loss, or liver damage. These treatments also can weaken your immune system and increase your risk for infection. Some people may experience a serious complication called graft-versus-host disease if the donated stem cells attack the body. Other people may reject the donor stem cells after the transplant, which can be an extremely serious complication.

Sometimes, a healthcare provider will order a bone marrow biopsy, a diagnostic test of a sample of red bone marrow, or a bone marrow transplant, a treatment in which a donor’s healthy bone marrow—and its stem cells—replaces the faulty bone marrow of a patient. These tests and procedures are often used to assist in the diagnosis and treatment of various severe forms of anemia, such as thalassemia major and sickle cell anemia, as well as some types of cancer, specifically leukemia.

In the past, when a bone marrow sample or transplant was necessary, the procedure would have required inserting a large-bore needle into the region near the iliac crest of the pelvic bones (os coxae). This location was preferred, since its location close to the body surface makes it more accessible, and it is relatively isolated from most vital organs. Unfortunately, the procedure is quite painful.

Now, direct sampling of bone marrow can often be avoided. In many cases, stem cells can be isolated in just a few hours from a sample of a patient’s blood. The isolated stem cells are then grown in culture using the appropriate hemopoietic growth factors, and analyzed or sometimes frozen for later use.

For an individual requiring a transplant, a matching donor is essential to prevent the immune system from destroying the donor cells—a phenomenon known as tissue rejection. To treat patients with bone marrow transplants, it is first necessary to destroy the patient’s own diseased marrow through radiation and/or chemotherapy. Donor bone marrow stem cells are then intravenously infused. From the bloodstream, they establish themselves in the recipient’s bone marrow.

Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. In time, myeloma cells collect in the bone marrow and in the solid parts of bones.

No one knows the exact causes of multiple myeloma, but it is more common in older people and African Americans. It can run in families. Common symptoms may include

• Bone pain, often in the back or ribs
• Broken bones
• Weakness or fatigue
• Weight loss
• Frequent infections and fevers
• Feeling very thirsty
• Frequent urination

Doctors diagnose multiple myeloma using lab tests, imaging tests, and a bone marrow biopsy. Your treatment depends on how advanced the disease is and whether you have symptoms. If you have no symptoms, you may not need treatment right away. If you have symptoms, you may have chemotherapy, stem cell transplantation, radiation, or targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

Plasma cell neoplasms are diseases in which the body makes too many plasma cells.

Plasma cells develop from B lymphocytes (B cells), a type of white blood cell that is made in the bone marrow. Normally, when bacteria or viruses enter the body, some of the B cells will change into plasma cells. The plasma cells make antibodies to fight bacteria and viruses, to stop infection and disease.

Plasma cell neoplasms are diseases in which abnormal plasma cells or cells form tumors in the bones or soft tissues of the body. The plasma cells also make an antibody protein, called M protein, that is not needed by the body and does not help fight infection. These antibody proteins build up in the bone marrow and can cause the blood to thicken or can damage the kidneys.

Plasma cell neoplasms can be benign (not cancer) or malignant (cancer).

Monoclonal gammopathy of undetermined significance (MGUS) is not cancer but can become cancer. The following types of plasma cell neoplasms are cancer:

• Lymphoplasmacytic lymphoma (also called Waldenström macroglobulinemia).
• Plasmacytoma.
• Multiple myeloma.

Myeloma, also called multiple myeloma, is a cancer of the plasma cells. Plasma cells are white blood cells that make antibodies that protect us from infection. In myeloma, the cells grow too much, crowding out normal cells in the bone marrow that make red blood cells, platelets, and other white blood cells.

What Causes Myeloma?

Scientists don’t understand why some people get myeloma and others don’t. Age is the most significant risk factor for developing myeloma. People younger than 45 years old rarely develop the disease. Men are more likely than women to develop myeloma, and myeloma is more than twice as common among black people as among white people. In rare cases, exposure to X-rays or other kinds of ionizing radiation may be a risk factor for developing myeloma.

What Are the Symptoms of Myeloma?

Sometimes myeloma does not cause any symptoms. It may be found when a blood or urine test is done for another condition and a higher than normal level of protein is found. When more advanced, symptoms of myeloma may include bone pain, especially in the back or ribs; bones that break easily; fever for no known reason; frequent infections; bruising or bleeding easily; trouble breathing; weakness of the arms or legs; and feeling very tired.

These symptoms can also come from other conditions. If you have any of them, talk to your doctor.

Multiple myeloma is considered a rare cancer; it accounts for about 10 percent of cancers of the blood and blood-forming tissues, and between one and two percent of all cancers. Multiple myeloma occurs in approximately 4 per 100,000 people per year; there are currently about 100,000 affected individuals in the United States.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired (not inherited) disorder that leads to the premature death and impaired production of blood cells. The disorder affects red blood cells (erythrocytes), which carry oxygen; white blood cells (leukocytes), which protect the body from infections; and platelets (thrombocytes), which are involved in blood clotting. PNH can occur at any age, although it is most often diagnosed in young adulthood.

People with PNH have sudden, recurring episodes of symptoms (paroxysmal symptoms), which may be triggered by stresses on the body, such as infections or physical exertion. During these episodes, red blood cells are broken down earlier than they should be (hemolysis). Affected individuals may pass dark-colored urine because of the presence of hemoglobin, the oxygen-carrying protein in blood. The abnormal presence of hemoglobin in the urine is called hemoglobinuria. In many, but not all cases, hemoglobinuria is most noticeable early in the morning, upon passing urine that has accumulated in the bladder during the night (nocturnal).

The premature breakdown of red blood cells results in a shortage of these cells in the blood (hemolytic anemia), which can cause signs and symptoms such as fatigue, weakness, abnormally pale skin (pallor), shortness of breath, and an increased heart rate (tachycardia). People with PNH may also be prone to infections because of a shortage of white blood cells (leukopenia).

Abnormal platelets associated with PNH can cause problems in the blood clotting process. As a result, people with this disorder may experience abnormal blood clotting (thrombosis), especially in large abdominal veins; or, less often, episodes of severe bleeding (hemorrhage).

Individuals with PNH are at increased risk of developing cancer in blood-forming cells (leukemia). In some cases, people who have or have been treated for another blood disease called aplastic anemia may develop PNH. In a small number of affected individuals, the signs and symptoms of PNH disappear on their own.

A very rare form of PNH involves abnormal inflammation in addition to the typical features described above. Inflammation is a normal immune system response to injury and foreign invaders (such as bacteria). In people with this rare form of PNH, the immune response is turned on (activated) abnormally and can cause recurrent aseptic meningitis (which is inflammation of the membranes surrounding the brain and spinal cord that is not related to infection); a red, itchy rash (known as hives or urticaria); joint pain (arthralgia); or inflammatory bowel disease. The inflammatory disorders usually begin earlier than the blood cell problems.