Diagnostic Accuracy of Peripheral Blood Film Examination in Comparison to Bone Marrow Aspiration in Various Haematological Disorders: A Cross-sectional Study

Abstract

Introduction: Bone marrow aspiration is a routine diagnostic procedure performed in hospitals for the diagnosis and management of haematological disorders. It involves cytomorphological assessment of all blood cells through bone marrow aspiration and Peripheral Blood Film (PBF) examination. Aim: To analyse the diagnostic accuracy of PBF in comparison to bone marrow aspiration for diagnosing various haematological diseases in southern Rajasthan, India. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Rabindra Nath Tagore (RNT) Medical College, Udaipur Rajasthan, India, from January 2016 to June 2022. The study included microscopic findings of 638 bone marrow cases along with corresponding PBF and complete blood count findings. The results were entered into an MS Excel sheet and evaluated using Statistical Package for the Social Sciences (SPSS) 22.00 software. Chi- square test was used to calculate p-values. Results: The study included a total of 638 bone marrow aspiration cases, with 368 cases (57.68%) being male and 270 cases (42.32%) being female. The mean age was 30.8 years (4 months to 87 years). The most common bone marrow diagnosis was Erythroid Hyperplasia, with 187 cases (29.31%) (including micronormoblastic, megalonormoblastic, normoblastic, and nutritional), followed by Chronic Myeloid Leukaemia (CML) with 154 cases (24.14%), and acute leukaemia with 152 cases (23.82%). Among the benign diagnoses, micronormoblastic erythroid hyperplasia was the most common with 68 cases (27.09%). Among the malignant diagnoses, CML was the most common with 154 cases (39.79%). The sensitivity of PBF diagnosis was 100% for Chronic Lymphocytic Leukaemia (CLL), CML, and Prolymphocytic Leukaemia (PLL), and 82.24% for acute leukaemia; 45.5% for lymphoma infiltration. The specificity was 100% for all cases. The accuracy was 95.75% for acute leukaemia, 99.06% for lymphoma infiltration, and 100% for CML, CLL, PLL, and myeloproliferative disorder-eosinophilia. The p-value was <0.001 for Acute Leukaemia, CML, CLL, PLL, myeloproliferative disorder-eosinophilia, and <0.002 for lymphoma infiltration. The overall sensitivity, specificity, accuracy, and p-value were 84.5%, 100%, 90.6%, and <0.001, respectively. Conclusion: While bone marrow examination is crucial for confirming the diagnosis of haematological disorders, PBF examination alone can be used for phasing and confirming the diagnosis of CML and CLL.