Abstract
BackgroundBone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital.MethodsA retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured.ResultsAltogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients’ median age was 43 years and the interquartile range was 27–60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia.ConclusionBone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.
Highlights
According to the Joint United Nations Programme on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) (UNAIDS), there were an estimated 7.5 million people living with HIV (PLWH) in South Africa in 2018.1 South African guidelines published in 2017, recommend that all adult PLWH regardless of the CD4 count are eligible to receive antiretroviral therapy (ART).[2]
The study was conducted at the National Health Laboratory Service (NHLS) Haematology laboratory at Tygerberg Hospital (TBH), a 1384-bed, multidisciplinary, tertiary care academic hospital in the Western Cape province of South Africa
As a result of the wide range of indications of bone marrow examination in this study and the limited number of cases with fever of unknown origin (FUO), the findings of this study should be compared with caution with other studies, which focused on the diagnostic utility of bone marrow examination in patients with fever and/or cytopenia
Summary
Human immunodeficiency virus is known to cause several haematological changes.[3,4] These include cytopenias, disseminated infections, immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), thrombosis and a higher risk of haematological malignancies, high-grade B-cell lymphoma.[3] Cytopenia, the most common haematological complication of HIV, can be due to direct infection of the haematopoietic cells with cytokine dysregulation, ineffective haematopoiesis or because of peripheral destruction or loss of blood cells.[5] Opportunistic infections such as mycobacterial and cryptococcal infections, with infiltration of the bone marrow, may occur. Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital
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