Starvation marrow in the tropics: Gelatinous bone marrow transformation as an underdiagnosed but reversible cause of pancytopenia.

This article focuses on gelatinous transformation of the bone marrow (GTBM), a reversible hematologic disorder characterized by marrow fat depletion, hypocellularity, and replacement by a mucopolysaccharide-rich gelatinous matrix that stains positive with Alcian blue. GTBM occurs primarily in the context of severe malnutrition, chronic infections, or systemic illnesses and presents clinically with pancytopenia and features of undernutrition. A case of an 18-year-old undernourished female with pancytopenia and a dry bone marrow tap is described, where biopsy confirmed GTBM. Recognition of GTBM is important for clinicians, especially in resource-limited settings, as timely nutritional rehabilitation and management of underlying conditions can restore bone marrow function.