High frequency of infection with tuberculosis as the most common cause of bone marrow necrosis: a study from tertiary care centre in northern India and their clinico-pathologic analysis

Abstract

Bone marrow necrosis (BMN) is seen in various malignant and non-malignant disorders. The relative frequency ranges between 0.37 and 6.5 % in western countries. The aim of this study is to analyze various etiology and prevalence at our tertiary care center and to compare our clinico-pathologic profile of this uncommon entity to western data. This is a retrospective observational study done in the Department of Hematology, tertiary care centre in northern India over a period of 21 months. Various clinical features and laboratory parameters of the cases showing BMN were noted from hospital records. Bone marrow trephine biopsies with BMN were graded semi-quantitatively according to the criteria laid down by Maisel et al. grading system into three grades I, II, and III as area of the biopsy showing necrosis like <20, 20–50, and >50 %, respectively. Bone marrow necrosis was observed in 1.8 % of bone marrow biopsies studied for various clinical indications over the study period. Median age was 35 years with male to female ratio of 3.4:1. Underlying non-malignant disease was seen in 64.4 % cases with tuberculosis as the most common etiology (59.32 %). Among malignancies, hemato-lymphoid malignancies were observed in 23.72 % cases. On semi-quantitative grading, bone marrow biopsies revealed grade I, II, and III necrosis in 62.71, 18.64, and 18.64 % of cases, respectively. BMN is rare clinico-pathological entity with a poor prognosis. Although the etiology of BMN is varied, this differential possibility should be kept in mind in any patient presenting with bicytopenia or pancytopenia especially in the setting of infection and malignancy. Tuberculosis should always be an important differential diagnosis in developing countries like India, before considering malignancy.