Abstract
ObjectiveThis study evaluated the importance of bone marrow aspiration and trephine biopsy (BM) for the diagnosis of underlying hematological abnormalities in renal patients.MethodsThis cross-sectional study on BM was carried out between August 2010 and April 2019, in our specialist renal center for various unexplained hematological abnormalities in patients with renal diseases [chronic kidney disease (CKD), end-stage renal disease (ESRD) requiring maintenance hemodialysis (MHD), patients with normal renal function but other nephrology and urology issues like stone disease and nephrotic syndrome].ResultsOut of 176 reported BM examinations, 48 (27.3%) were done on ESRD patients on MHD (CKD-D), and 69 (39.2%) on CKD patients not on MHD (CKD-nD). Fifty-nine (33.5%) BM were done on patients with normal renal function (n-CKD). The indication for BM was pancytopenia 50 (28.4%), unexplained anemia 39 (22.2%), and unexplained thrombocytopenia 43 (24.4%). In 91 (51.7%) patients BM was normal. In 30 (17%) patients multiple myeloma (MM) was diagnosed on BM, out of which 18 (26.1%), nine (18%), three (5.3%) were CKD-nD, CKD-D, and n-CKD patients, respectively. In 11 (6.3%) patients BM was suggestive of myelodysplasia (MD), out of these 11 patients, five (10%) were CKD-D patients.ConclusionBM is an underutilized method of diagnosis of hematological abnormalities in renal patients. Our study revealed the importance of BM examination, especially in patients with CKD.
Highlights
Chronic kidney disease (CKD) is growing as a public health burden especially in third world countries like Pakistan
In 11 (6.3%) patients BM was suggestive of myelodysplasia (MD), out of these 11 patients, five (10%) were chronic kidney disease (CKD)-D patients
CKD is associated with various hematological changes including anemia, prolonged bleeding time, platelet and white blood cell dysfunction, pancytopenia, thrombocytopenia, and coagulopathies [7]
Summary
Chronic kidney disease (CKD) is growing as a public health burden especially in third world countries like Pakistan. The prevalence of CKD is variable in different countries. It is 4.3-16.7% in USA [1], 17.3% in Germany [2], 6.7-18.3% in China [3], 0.7-17.2% in India [4], and 5.0-31.2% in Pakistan [5,6]. CKD is associated with various hematological changes including anemia, prolonged bleeding time, platelet and white blood cell dysfunction, pancytopenia, thrombocytopenia, and coagulopathies [7]. Thrombocytopenia, platelet dysfunction, and coagulopathies increase the risk of bleeding, while abnormalities in the function of white blood cells increase the risk of infection in these patients
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