What is the role of peripheral blood and bone marrow in the etiology of paroxysmal nocturnal hemoglobinuria (PNH)?

Updated: May 20, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Answer

In PNH, the peripheral blood and bone marrow is a mosaic composed of GPI-AP+ and GPI-AP– cells; with GPI-AP–, cells can be derived from multiple mutant stem cells. The GPI-AP– mutant cells may appear to dominate hematopoiesis in PNH by providing a proliferative advantage under some pathologic conditions. For example, if damage to stem cells causing bone marrow failure is mediated through a GPI-linked surface molecule, the PNH cells lacking these molecules will survive. The close association of PNH with aplastic anemia and myelodysplastic syndrome (MDS) suggests that the selection process arises as a consequence of this specific type of bone marrow injury.


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