Correlation of Bone Marrow Aspirate, Biopsies and Touch Imprint Findings in Pancytopenia

Abstract

Background: Pancytopenia is the feature of many life threatening conditions. It is described as the deficiency of all three cellular elements of blood resulting in anemia, leucopenia and thrombocytopenia. It is a common hematological entity that we come across in routine practice. A comprehensive clinical, hematological and bone marrow study of patients usually helps in identification of the underlying cause. However in view of a wide array of etiological factors pancytopenia continues to be a challenge. Aspiration of the marrow is an indispensible adjunct to the study of hematopoietic disorders, if performed correctly. It is simple, safe and can be repeated. In case of trephine biopsy the greater value is that it can provide information about the structure of relatively large pieces of marrow. At the same time morphological features of individual cells may be identified by making imprint from the material obtained. Hence the present study was undertaken to evaluate the accuracy of the three components of marrow examination in the diagnosis of hematological disorders presenting with pancytopenia. Methods: A total of 58 patients presenting with pancytopenia on initial workup requiring bone marrow aspirate and biopsy at MS Ramaiah medical college and hospital, Bangalore were studied from October 2009 to September 2011. Smears were made from the bone marrow aspirate (BMA), stained by Leishmann stain and examined. Touch imprints of bone marrow biopsy (BMB) were made and examined before the tissue was put in fixative (10% neutral buffered formalin) and subsequently processed, embedded in paraffin and sections were prepared and examined. Results: Fifty eight patients with hematological diagnosis of pancytopenia were studied during the period October 2009 to September 2011. The sex distribution of pancytopenia showed male preponderance (60%). Most of the patients were in the age group of 21 - 30 years (25%) and least occurrence was seen in patients more than seventy years (3.45%). The commonest cause of pancytopenia was megaloblastic anemia (39.65%), followed by nutritional anemia (24.13%) and Aplastic anemia (12.06%). Eleven patients (18.9%) were diagnosed on bone marrow biopsy. Forty four out of the total fifty eight cases showed a positive correlation. Conclusion: The commonest cause of pancytopenia was megaloblastic anemia. Clinical history and bone marrow examination is critical in arriving at the diagnosis. There was a positive correlation of 75.8% between BMA and BMB. Both the procedures were complimentary to each other and should be performed simultaneously along with imprint smears for complete bone marrow workup and evaluation. doi: http://dx.doi.org/10.4021/jh76w