Evaluation of bone marrow in patients with pancytopenia

Rupal Shah,Kazoomi Patel

doi:10.18231/j.pjms.2020.045

Abstract

Introduction : Pancytopenia is common hematological term described as decreased red blood cells, white cells and platelets in blood caused by either reduced production of haematopoietic cells in bone marrow or secondary destruction or reduction by drugs, toxins, radiotherapy, chemotherapy, infection etc. The diagnosis of causes for it are difficult to decide but few minimal invasive methods like bone marrow aspiration(BMA) and biopsy (BMB)are very useful. Objectives: To evaluate the diagnostic role of BMA and BMB in pancytopenia. Materials and Methods: This was observational study conducted over a period of 36 months on 145 patients. All age patients with new onset pancytopenia fulfilling inclusion criteria were included. Exclusion criteria: Radiation/chemotherapy induced pancytopenia. BMA and BMB were done in all cases. BMA smears were air dried and stained by Romanowsky stains while biopsy was fixed in formalin and sent for paraffin sectioning. BMA and BMB were analysed and data was statistically analysed. Results: Out of 145 patients, The mean age of the patients was 46years.Pallor and generalized weakness were commonest clinical complaints. Megaloblastic anemia was the most common cause (32%) followed by hypoplastic marrow in 16% cases. Rest causes were acute leukemia, anemia, myelodysplastic syndrome, metastases etc. Conclusion: BMA is good for studying morphology of hematopoietic cells while BMB for assessing cellularity and structure of bone marrow like fibrosis, infiltration & metastasis. BMA and BMB are complimentary with each other when used together for evaluation of bone marrow in routine haematological disorders. Keywords: Bone Marrow Aspiration, Bone Marrow Biopsy, Pancytopenia.

Highlights

Pancytopenia is common hematological term described as decreased red blood cells, white cells and platelets in blood caused by either reduced production of haematopoietic cells in bone marrow or secondary destruction or reduction by drugs, toxins, radiotherapy, chemotherapy, infection etc
Pancytopenia is common hematological term described as decreased red blood cells, white blood cells and platelets caused by either reduced production of haematopoietic cells in bone marrow or secondary destruction or reduction by drugs, toxins, radiotherapy, chemotherapy, infection etc. 1,2 Laboratory parameters are-haemoglobin< 9 gm/dl, WBC < 4,000/cmm, and platelets < 1,00,000/cmm
Hypercellular bone marrow was noted in megaloblastic anemia, acute leukemia, Myelodysplastic syndrome (MDS), reactive conditions, lymphoma, immune thrombocytopenic purpura (ITP)and few cases of myeloproliferative neoplasm (MPN)

Summary

Introduction

Pancytopenia is common hematological term described as decreased red blood cells, white cells and platelets in blood caused by either reduced production of haematopoietic cells in bone marrow or secondary destruction or reduction by drugs, toxins, radiotherapy, chemotherapy, infection etc. The diagnosis of causes for it are difficult to decide but few minimal invasive methods like bone marrow aspiration(BMA) and biopsy (BMB)are very useful. Objectives: To evaluate the diagnostic role of BMA and BMB in pancytopenia. Conclusion: BMA is good for studying morphology of hematopoietic cells while BMB for assessing cellularity and structure of bone marrow like fibrosis, infiltration & metastasis. 4 The clinician has to apply comprehensive approach by detailed analysis of history, laboratory parameters and bone marrow study to reach correct cause of new onset pancytopenia. BMA and BMB are complimentary with each other when used together for evaluation of bone marrow in routine haematological disorders. This study is done to statistically analyze the diagnostic value of both procedures and the lacuna observed when any one of the procedure performed alone.

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