Bone Marrow Aspiration Cytology Research Articles

Diagnostic Utility of Bone Marrow Aspiration, Trephine Biopsy, and Flow Cytometry in the Evaluation of Various Haematological and Non Haematological Disorders: A Cross-sectional Study from Northern India

Introduction: The spectrum of haematological and non haematological disorders is vast in various age groups. Complete blood counts and other routine laboratory tests are not always sufficient to diagnose these diseases. Bone marrow examination plays an important role in diagnosing their underlying causes. Aim: To analyse the spectrum of various haematological and non haematological disorders reported in Bone Marrow Aspiration (BMA) and compare them with Bone Marrow Trephine Biopsy (BMB) and Flow Cytometry (FCM) findings where applicable. Materials and Methods: A one-year cross-sectional study was conducted in the Department of Clinical Pathology, PGIMS, Rohtak, Haryana, India from April 2022 to March 2023. A total of 518 consecutive BMA samples were morphologically analysed. Comparative evaluations were performed among BMA, BMB, and FCM where applicable. Diagnostic accuracy was calculated, and the findings of discordant cases were tabulated. Definitive diagnosis of lymphoma/leukaemia and Paroxysmal Nocturnal Haemoglobinuria (PNH) cases were made using FCM. Results: The patients’ ages ranged from three months to 86 years, with a mean age of 38.4 years. The male to female ratio was 1.3:1, with a slight male predominance. The highest number of cases were of anaemia {183 (35.3%) and 164 (31.7%), respectively} and leukaemia {128 (24.7%) and 134 (25.9%), respectively}, followed by normal marrow studies {39 (7.5%) and 32 (6.2%), respectively} and megakaryocytic thrombocytopenia {24 (4.6% in each} in both BMA and biopsy. Among anaemia cases {183 and 164 cases in BMA and BMB}, the majority were of the megaloblastic type {62 (33.8%) and 54 (32.9%), respectively}, followed by hypoplastic/aplastic type {40 (21.8%) and 50 (30.5%), respectively}. In cases of leukaemia (128 and 134 cases in BMA and BMB), acute leukaemia cases (76 (59.4%) and 82 (61.2%), respectively} outnumbered chronic leukaemia cases {52 (40.6%) and 52 (38.8%), respectively} in both BMA and BMB. The concordance and discordance rate between BMA and BMB were 87.6% (419 cases) and 12.4% (59 cases), respectively. Diagnosis was exclusively made by BMB in cases of myelofibrosis, granulomatous disease, and Hodgkin’s lymphoma. Conclusion: BMA cytology is a relatively safe and mildly invasive technique for evaluating various haematological and non haematological disorders with better preservation of cellular morphology. However, in cases with dry/blood taps and focal marrow involvement, BMB should be performed, as it shows well-preserved marrow architecture with all its cellular and stromal components. FCM is a definitive diagnostic modality for further categorisation of acute leukaemia and Chronic Lymphoproliferative Disorders (CLPD).

Diagnostic Utility of Bone Marrow Aspiration Cytology- A Hospital Based Prospective Study at Nepalgunj Medical College

Introduction: Hematological disorders are common in all age groups and are worldwide in distribution. At times, routine hematological tests are not sufficient to diagnose blood disorders. Bone marrow examination serves as an important diagnostic aid to evaluate various neoplastic and non-neoplastic hematological diseases.
 Aims: To study role of Bone Marrow Aspiration Cytology in diagnosing hematological disorders. 
 Methods: This is a one-year hospital based prospective study done at Department of Pathology, NGMC, Kohalpur. It included 34 cases subjected to Bone marrow aspiration cytology. Correlation with Peripheral Blood Smear, Reticulocyte count, pearls iron stain and other parameters were done before giving the final diagnosis.
 Results: Age of patients ranged from 10-82 years with equal gender distribution. Common indications for Bone marrow examination were pancytopenia (50%), followed by Anemia and Thrombocytopenia. Megaloblastic Anemia (n=10,29%) was the commonest Anemia followed by mixed nutritional deficiency and Iron Deficiency Anemia. Hematological Malignancy accounted for six cases, of which Acute Myeloid Leukemia was diagnosed in two cases. Infectious causes comprised of two cases of Visceral Leishmaniasis and one case of Bone Marrow Tuberculosis.
 Conclusion: Bone marrow aspiration cytology serves as an important adjunct in diagnosing hematological disorders. More reproducible results are obtained if bone marrow biopsy is done in conjucntion with aspiration cytology.

Acute Leukaemias in Bauchi State, Northeastern Nigeria: Pattern of Presentations and Clinical Entities

Background: Acute leukaemias are very aggressive diseases that run a rapidly fatal course if not promptly diagnosed and appropriately treated. The clinical presentations range from bone marrow failure such as anaemia, neutropenia or thrombocytopenia to features of organ infiltrations such as lymphadenopathy, splenomegaly, etc, but presentations may be non-specific. Misdiagnosis is very common with delay in diagnosis and prompt treatment being the causes of high morbidity and mortality in acute leukaemias. This study aims to determine the pattern of presentation and various clinical entities of acute leukaemias in Bauchi State, North-Eastern Nigeria.
 Subjects, materials and methods: This was a three year retrospective study in which records of cases of acute leukaemias diagnosed in the Haematology Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi from the bone marrow aspiration cytology register from 1st January, 2018 to 31st December, 2020 were collected. Data on socio-demographic characteristics of the patients that include age, gender, diagnosis as well as subtypes of some of the malignancies diagnosed were also collated. The collated data were analyzed using SPSS Version 20.0. A p-value of < 0.05 was considered significant.
 Results: Twenty-nine cases of acute leukaemias were diagnosed during the period under review. Majority of cases had acute lymphoblastic leukaemia (ALL) 19/29 (65.5%) while acute myeloid leukaemia (AML) was seen in 10/29 (34.5%). The mean ± SD age of the patients was 22.2±9.2 years with a range 6 months to 60 years. Males constituted 75.9% (22/29) of the cases of acute leukaemias diagnosed. The male to female ratios for AML and ALL were 2:1 and 2.6:1 respectively. The mean±SD ages for AML and ALL were 27±9.2years and 17.3±11.3 years respectively. The most common form of presentation of acute leukaemia in this study is recurrent anaemia necessitating blood transfusion while proptosis and epistaxis were the least forms of presentation.
 Conclusion: Acute lymphoblastic leukaemia is the commonest form of acute leukaemias while recurrent anaemia is the commonest form of clinical presentations in our setting. Early referral of patients with clinical features suggestive of acute leukaemias is recommended.
 Author
 R A Dachi 1, F G Mustapha 1, M Mahdi 1, H Abbas 2

CYTOLOGICAL DIAGNOSIS OF CUTANEOUS MYELOID SARCOMA-A RARE CASE REPORT

Introduction: Granulocytic sarcoma or myeloid sarcoma also known as chloroma is a rare extramedullary tumour which may occur as a manifestation of acute myeloid leukaemia, myelodysplastic syndrome or blast crisis in chronic myeloproliferative disorder or may precede systemic leukaemia. Most common site includes skin, soft tissue and lymph nodes. Orbit is most commonly involved in paediatric age group. Case Report: A case of 51 years old female was admitted in department of haematology, presented with multiple nodules in nasal cavity, forehead, bilateral arms and whole abdomen. Bone marrow aspiration cytology shows 21% myeloid blast with transformation of the CML to AML.FNAC was done from multiple nodules which showed plenty of myeloid precursors and blast and diagnosis of granulocytic sarcoma was given. BCR-ABL study came out positive and karyotyping for haematological malignancy showed t (5; 12)(q31;24.3). Patient was given chemotherapy, but showed no improvement. Conclusion: Granulocytic sarcoma (GS) is a rare malignant solid tumour in adults. Diagnosis of GS has been a problem for pathologist because of relatively immature nature of tumour cells and mostly misdiagnosed as Non Hodgkin's lymphoma. Diagnosis of GS is considered as an adverse prognostic factor but early conrmation of diagnosis and treatment initiation might improve the prognosis.

A Case Report: Solitary Plasmacytoma of bone (SPB) Presenting as an Incidentaloma in a COVID-19 Positive Patient

A 70-yr-old covid positive male patient who presented with cough and shortness of breath, upon CT chest found to have features typical of COVID-19 infection and a small mass arising in left 8th rib. A histopathological examination of the mass found to be osseous plasmacytoma, after a PET scan it was confirmed to be a solitary lesion. Bone marrow aspiration cytology showed normal plasma cell count, thus, diagnosed as solitary Plasmacytoma of bone. There was no negative impact on the recovery of the patient by COVID-19 due to solitary Plasmacytoma.

A BONE MARROW ASPIRATION STUDY IN FEMALES: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

Background: Bone marrow aspiration (BMA) cytology is a common and cheap technique which reveals the marrow cellularity,its structure,and stages of differentiation of different blood cells.Objectives:The objectives of the study were to study the incidence , etiology and the common presentation in patients undergoing BMA with special focus on the females.Materials and Methods: This is a retrospective study that was carried out in the Department of Pathology of RIMS Ranchi, India. The study was done from January 20121 -September 2021 on 292cases . BMA was carried out and relevant clinical history,physical examination, and laboratory data were retrieved. Results: Out of 292 cases, 14 cases were excluded from the final analysis due to inadequate marrow. Male-to-female ratio was 1.24:1 The most common indication was unexplained anemia and bleeding.The most common etiological diagnosis was erythroid hyperplasia EH (35.6% microcytic EH-22% and megaloblastic EH-13%) followed by acute luekemias(16%). Among adolescents (>11– 20 years)-23% and reproductive age group females -21% where erythroid hyperplasia was the most common cause followed by acute luekemia. Conclusion: The common hematological disorders prevailing in females are erythroid hyperplasia (microcytic EH and EH with megaloblastic changes) main cause being nutritional anemia followed by acute leukemia.

Hairy cell leukemia - A case report with recent updates

Hairy cell leukemia (HCL), a rare, chronic B-cell leukemia, first described as a distinct entity in 1958, was recognized as an entity by the World Health Organization in 2008. The disease accounts for 2% of all leukemias and is more frequent in middle-aged to older men. The diagnosis is based on the hairy lymphoid cells in the peripheral smear and the bone marrow aspiration cytology and the bone marrow biopsy showing a monotonous interstitial infiltrate with a fried egg appearance. The classic immunophenotypic profile in the flow cytometry and the V600E mutation confirm the diagnosis. Herein we report a 52- year-old male patient presented with pancytopenia, high-grade fever, and weight loss. The characteristic histomorphological and the flow cytometry features of this leukemia will be used to discuss further the recent updates on the distinct clinicopathologic features, differential diagnosis, treatment, and prognosis of the entity.

Late Presentation, Advanced Disease and Severe Acute Malnutrition are Common Among Children with Cancer in Tanzania

Background Majority of children with cancer live in low and middle-income countries (LMIC) where survival is disproportionately low compared to high-income countries (HIC). Among the challenges of managing childhood cancers in LMIC is late presentation, advanced disease, and the prevalence of severe malnutrition. Advanced disease and severe acute malnutrition are associated with poor treatment outcomes. Methodology This was a descriptive study conducted in Tanzania at Ocean Road Cancer Institute (ORCI) in 2010. Children and adolescents below 18 years were longitudinally enrolled in the study. Pathological diagnosis was made by examination of tissue biopsies, fine needle aspiration (FNAC) or bone marrow aspiration cytology (BMAC). Stage of disease at presentation was determined by physical examination and radiological investigations such as chest x-ray and ultrasonography. World Health Organization (WHO) anthropometric measurement chart was used to interpret measured Mid-upper arm circumference (MUAC) for age. Body mass index (BMI) is affected by tumour weight hence was not used to assess malnutrition in this study. Results One hundred and fifty-one (151) patients were enrolled in the study. The mean age at presentation was 5.8 years (range 3-17years), and 51.7% of participants were males. Three quarters (76.6%) of patients attended the first health facility within a month of onset of symptoms, but forty per cent (40%) of patients took six (6) months to reach ORCI for treatment. Eighty-six percent (86%) of patients presented with advanced disease (50.8% - locally advanced, 35.1% - metastatic disease). Metastatic disease was more frequent in patients with Neuroblastoma (NB) and Non Hodgikins Lymphoma (NHL) (66.6% each), Burkitt’s lymphoma (BL) (50%), Soft tissue sarcoma (STS) (40%) and Wilm’s tumour (WT) (35.3%). Severe wasting was seen in 12.6% of patients, and more prevalent among patients with BL (31.3%) and WT (25%). Conclusion Even though most patients sought health care early, they reached ORCI late with advanced disease (86%), and 12.6% had severe acute malnutrition. Keywords: Children, Cancer, Advanced Disease, Malnutrition.

Prevalence and Nature of Adult Hematological Malignancies Using Bone Marrow Aspiration Cytology in a Tertiary Health Facility: A Seven Year Retrospective Review

Bone Marrow Aspiration (BMA) is a procedure that is often used to evaluate patients with haematological disorders including haematological malignancies (HMs) which account for about 6.5% of all cancers worldwide. There is paucity of data on the prevalence and pattern of HMs from BMA cytology in Nigeria. We carried out a retrospective review to determine the prevalence and distribution of HMs among adult patients who had BMA cytology at Benue State University Teaching Hospital (BSUTH) from June 2012 to July 2019. A total of 158 BMA reports extracted from the marrow and clinic medical records were reviewed. Out of 158 adult BMA cytology reports, HMs accounted for 78(49.4%) of all haematological disorders. There was no significant gender difference. The Male 38(48.7%) to Female 40(51.3%) ratio (M:F) was 1:1.1. Their ages ranged from 16 to 85 years with the median age of 54.0 years. Out of the 78 HMs, Lymphoid neoplasms were the most prevalent 47(60.3%), the leukaemias were higher 53/78(67.9%) compared to the non-leukaemic neoplasms. Of the 53 leukaemias, those of chronic lymphoid types were more 24/53(45.3%), followed by the chronic myeloid 15/53(28.3%). Chronic lymphocytic leukaemia (CLL) was the predominant leukaemia 24/53(45.3%) as well as the most prevalent HM 24/78(30.8%), followed by chronic myeloid leukaemia (CML) 19.2%(15/78). Others were myelodysplastic syndrome (MDS) 11.5%(9/78), acute lymphoblastic leukaemia (ALL) 10.3% (8/78), multiple myeloma (MM) 10.3%(8/78), acute myeloblastic leukaemia (AML) 7.7%(6/78), non-Hodgkin's lymphoma (NHL) 6.4%(5/78), Small lymphocytic lymphoma (SLL) 2.6%(2/78) and Hodgkin's lymphoma (HL) 1.3%(1/78). In conclusion, we established high prevalence of HMs among patients who had BMA cytology evaluation at BSUTH with the preponderance of lymphoid malignancies. We advocate for inclusion of HMs in the National Health Insurance Scheme (NHIS) for full implementation and to prioritise provision of modern diagnostic equipment and treatment options for quality and optimal management of leukaemias in the center.

Pattern Of Haematological Malignancies In A Tertiary Health Facility In Bauchi State, Northeastern Nigeria

Background: Haematological malignancies are clonal disorders of haemopoietic stem cells that are characterized by abnormal proliferation and accumulation of malignant cells in the various body tissues and organs. Objective: The objective of the study was to determine the pattern of haematological malignancies in Bauchi Sate, Northeastern Nigeria. Materials and Methods: This was a retrospective study where records of haematological malignancies diagnosed in the Haematology and Histopathology departments of Abubakar Tafawa Balewa University Teaching Hospital Bauchi from the bone marrow aspiration cytology register as well as the cancer registry respectively from 1st January, 2018 to 31st December, 2020 were collected. Data on socio-demographic characteristics of the patients were also collected. The collated data were analyzed using SPSS Version 20.0. Continuous variables with z-scores within ±2.58 for skewness and kurtosis were considered to be normally distributed. Normally distributed data were reported as means ± standard deviations (SD) while non-normally distributed data were reported as median (interquartile ranges). Categorical data were reported as percentages. Results: Seventy-one (71) cases of haematological malignancies were diagnosed during the period under review in which a total of 601 cancer cases were diagnosed, constituting a frequency of 11.8% of all cancers. The median (IQR) age of the patients diagnosed with haematological malignancies was 18.9(6.2) with a range of 2.5 to 70 years. Acute lymphoblastic leukaemia (ALL) was the commonest while T-cell Non-Hodgkin lymphoma was the least diagnosis during the period under review. The distribution of the histologic subtypes of Hodgkin lymphomas (HL) revealed nodular sclerosis and mixed cellularity as the commonest subtypes with equal frequency (4/7 (42.9%) each) while no cases of lymphocyte rich and lymphocyte depleted were seen. Conclusion: Haematological malignancies are common in our setting and acute lymphoblastic leukaemia is the commonest malignancy in our environment. Physicians are encouraged to be looking for the early symptoms and signs of these malignancies.

Parvovirus Infection Causing Aplastic Anaemia in an Immunocompetent Patient Diagnosed by Bone Marrow Aspiration Cytology

Human Parvovirus infection is associated with transient aplastic crisis as a most common complication in chronic haemolytic anaemia patients. Very few case reports are available regarding aplastic crisis in immunocompetent patients. Here the authors are reporting a case of 17-year-old immunocompetent male that presented with fever, headache for three days. Complete blood count showed pancytopenia. Bone marrow aspiration and trephine biopsy revealed hypocellularity. Giant pro-erythroblasts with multiple cytoplasmic projections (dog ear appearance) and prominent intranuclear inclusions were seen in marrow aspirated cytology. Classical cytological findings in bone marrow aspiration raised the suspicion of human parvovirus infection. Findings were confirmed by positive Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) for parvovirus B19 and parvovirus Immunoglobulin M (IgM) antibody using Enzyme Linked Immunosorbent Assay (ELISA) test. Patient was managed with antibiotic therapy and was trasfused three units of blood. Complete blood count became normal after two months. This emphasises the role of keeping high index of suspicious for Parvovirus B19 infection as a cause of aplastic anaemia even in individual without underlying diseases. Secondly characteristic morphological changes in the erythroid precursors in the bone marrow aspiration is highly suggestive of Parvovirus B19 infection.

Acute Lymphoblastic Leukaemia: A Case Report of Long-term Disease-free Survival in a Resource Limited Setting

Acute Lymphoblastic Leukaemia (ALL) a malignant proliferation of immature lymphoid cells is a biologically heterogeneous disorder with variable outcomes in adults. We present a case report of a 54-year-old woman who presented with fever, anaemia and peripheral lymphadenopathy of four weeks duration, and was managed for disseminated tuberculosis initially. Full blood count and bone marrow aspiration cytology constituted part of her initial investigations and were found to be in keeping with acute lymphoblastic leukaemia (ALL-L3). Patient had supportive treatment and managed with Cyclophosphamide, Vincristine (Oncovin), Cytosine Arabinoside and Prednisolone (COAP Regimen), achieved complete clinical and haematologic remission, and has remained disease free after consolidation and maintenance therapy. No evidence of haematologic or clinical relapse at five years and currently in her ninth-year post diagnosis and treatment. With high index of suspicion, timely investigation and referral, satisfactory outcomes are achievable in managing some patients with acute lymphoblastic leukaemia.

A RETROSPECTIVE CROSS SECTIONAL STUDY ON PATTERN & DISTRIBUTION OF PEDIATRIC HEMATOLOGICAL MALIGNANCIES IN CENTRAL PART OF INDIA

Hematological Malignancies (HMs) consists of a diverse group of neoplastic diseases involving Bone Marrow, Lymph nodes or other Secondary Immune Organs. Conventionally, HMs represents 2 major group of diseases – Leukemia & Lymphoma. All Hematological Malignancies are on the rise as compared to few decades back worldwide but, it’s major brunt is faced by the under developed countries of the world. A retrospective study in a Government Teaching Hospital was undertaken to characterize Pattern and Distribution of HMs in children in Chhattisgarh state of India. A total number of 65 Bone Marrow Aspiration Cytology cases were evaluated from 1st January 2019 to 31st December 2019 for a period of 1 year. Pediatric Population was categorized into 3 age groups – 0-2 years, 2-12 years and 12-16 years. Male to Female ratio was 2.4:1 in our study with most cases being of Acute Leukemias (95.4%). On further evaluation, ALL had highest numbers with 37 cases (57.0 %) followed by Acute Leukemia and AML with 14 (21.52%) & 10 (15.38%) cases respectively. The highest number of cases were seen in 2-12 years age group (n=49, 75.4%) implying that children of such age group presenting with signs and symptoms of HMs must be thoroughly evaluated for early diagnosis and treatment.

Clinicohematological profile of pancytopenia: a study from a tertiary care hospital

Background: Pancytopenia is common clinical condition which we encounter in our daily clinical practice. Pancytopenia is characterized by decrease in all the three major components of blood like Red Blood Corpuscles, White blood Corpuscle, and platelets. This study was carried out to look for causes of pancytopenia and clinical presentations at tertiary care hospital in north India.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between June 2018 to July 2019. Total 125 patients who attended department of medicine were screened for study. After exclusion 94 patients were studied prospectively.Results: Out of 94 patients 59 were males, and 35 females in the study group. Male to female ratio was 1.6:1. Maximum patients were between 20 years to 35years of age group. Pallor and weakness were most common clinical feature in this study group. Out of various etiological causes vitamin B12 deficiency was the commonest in our study. 48(51%) patients had megaloblastic anemia due to vitamin B12 deficiency. Second most common etiological factor was hypo plastic/aplastic anemia. Other etiological abnormalities were hypersplenism, dengue, malaria, sepsis, myelodysplastic syndrome and multiple myeloma.Conclusions: Bone marrow examinations, aspiration cytology or biopsy are important tool for diagnosis of pancytopenia. Underlying cause and severity of disease determine the outcome of pancytopenia. The present study concluded that most of patients with pancytopenia have treatable cause so early diagnosis will be helpful for management of patients.

Hormonal contraceptive induced immune thrombocytopenic purpura

Immune thrombocytopenic purpura (ITP) is an acquired disorder of platelets that clinically manifests with mucocutaneous bleeding. There areseveral causes of ITP, but its association with hormonal contraceptive implants has not been widely reported. A 39‑year‑old Para 10+0 7 alivepresented to the Yobe State University Teaching Hospital with complaints of nasal bleeding, gum bleeding, purpura, and menorrhagia, whichwere noticed a month after insertion of a Levonorgestrel – containing hormonal contraceptive implant, at a Primary Healthcare facility. Completeblood count, peripheral blood film, and bone marrow aspiration cytology led to the diagnosis of ITP. Epistaxis was managed conservatively.The patient was placed on prednisolone with a noticeable increase in platelet count and remarkable improvement in the clinical state. ITP is acomplication of the hormonal contraceptive implant. Clinicians should be aware of the possible association of contraceptive implants and ITP. Keywords: Hormonal contraceptive implants, immune thrombocytopenic purpura, mucocutaneous bleeding, prednisolone

Etiological study of bone marrow aspiration cytology in children in a tertiary care government hospital in India with a special focus on adolescent females

Background: Bone marrow aspiration (BMA) cytology is a common and cheap technique which reveals the marrow cellularity, its structure, and stages of differentiation of different blood cells. Objectives: The objectives of the study were to study the etiology and the common presentation in patients undergoing BMA in pediatric age group with special focus on the adolescent females. Materials and Methods: This cross-sectional descriptive study was carried out in the Department of Pediatrics and Pathology of a Medical College Hospital of Bihar, India. The study was done from May 1, 2018, to April 31, 2019, on 259 cases. BMA was carried out and relevant clinical history, physical examination, and laboratory data were retrieved. Results: Out of 259 cases, 1 case was excluded from the final analysis due to inadequate marrow. Male-to-female ratio was 1.16:1. The most common indication was unexplained anemia (46.5%) and pancytopenia (26.7%). The most common etiological diagnosis was nutritional anemia (27.5%) followed by hypoplastic anemia (22%). Among adolescents (>11–18 years), male:female ratio decreased to 1:1 where nutritional anemia was the most common cause followed by hypoplastic anemia. Conclusion: The common hematological disorders prevailing in our community in pediatric age group are nutritional anemia, hypoplastic anemia, and acute leukemia.

The role of bone marrow aspiration cytology in the evaluation of the etiology of pancytopenia in patients in a tertiary hospital in Telangana, India

The role of bone marrow aspiration cytology in the evaluation of the etiology of pancytopenia in patients in a tertiary hospital in Telangana, India

Bone marrow aspiration cytology in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi State, Nigeria: Indications and diagnostic utility

Bone Marrow Aspiration (BMA) cytology is an important diagnostic and monitoring tool where cytological details of the marrow elements are examined using light microscopy. Various hematological diseases are diagnosed and monitored by using BMA. This study aimed at reporting a 3-year BMA experience of Department of Hematology and Blood Transfusion of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi. This was a retrospective study that involved the use of records of the bone marrow aspirates done from January 1st, 2016 to December 31st, 2018. The age, sex, indications for BMA, anatomical site and final bone marrow diagnosis were collated. The data was analyzed using SPSS Version 23.0 software. One hundred and three (103) bone marrow aspirations were performed during the period under review. Two third of the participants were males, with the median age of 40.0 years and a range of 5 months to 92 years. The commonest indication for BMA was recurrent anemia 45.6%, followed by splenomegaly, fever and lymphadenopathy with 11.7% each. While, the commonest diagnosis by BMA was megaloblastic anemia (28.2%). Mixed nutritional deficiency and Bone Marrow (BM) metastasis are the commoner BMA diagnoses with 12.6% each. Recurrent anemia is the commonest indication for BMA and nutritional anemias (megaloblastic and combined nutrients deficiency) are the commonest BMA diagnoses in Bauchi. Proper evaluation of patients by the clinicians before referral is recommended to ensure that only those that really need the procedure are subjected to it.

Comparison of Bone Marrow Aspiration Cytology, Touch Imprint Cytology and Bone Marrow Biopsy for Bone Marrow Evaluation at a Tertiary Health Care Institute

Introduction: Bone marrow examination is an important investigation in haematology which involves Bone Marrow Aspiration (BMA), Bone Marrow Imprint (BMI) and Bone Marrow Biopsy (BMB). Aim: Correlation of findings of bone marrow aspiration and imprint smears with biopsy in hematological disorders. Materials and Methods: It was a prospective study to correlate bone marrow examination findings by BMA, BMI and BMB of 111 patients in which bone marrow biopsy was done and correlated with aspirate and imprint smears. For aspiration Salah's needle and for biopsy Jamshidi needle were used. Correlation of hematological and histopathological findings was done. Results: Megaloblastic anaemia was the commonest diagnosis followed by acute leukemia, nutritional anaemia, chronic leukemia, multiple myeloma, leukemia/lymphoma syndrome, and essential thrombocythemia. In case of dry aspirate or diluted marrow biopsy was useful to diagnose aplastic anemia, and secondary myelofibrosis associated with acute and chronic leukemia, multiple myeloma, leukemia/lymphoma syndrome and myelomonocytic leukemia. Aspirate and imprint smears were better for cellular morphology. Conclusion: Aspiration and imprint smears give better morphological details/cytologic diagnosis. In dry tap or diluted marrow, biopsy was more helpful in identifying architectural pattern, cellularity and fibrosis whereas imprint smears were more helpful for cellular morphology. BMA, BMI and BMB are complimentary to each other.Introduction: Bone marrow examination is an important investigation in haematology which involves Bone Marrow Aspiration (BMA), Bone Marrow Imprint (BMI) and Bone Marrow Biopsy (BMB). Aim: Correlation of findings of bone marrow aspiration and imprint smears with biopsy in hematological disorders. Materials and Methods: It was a prospective study to correlate bone marrow examination findings by BMA, BMI and BMB of 111 patients in which bone marrow biopsy was done and correlated with aspirate and imprint smears. For aspiration Salah's needle and for biopsy Jamshidi needle were used. Correlation of hematological and histopathological findings was done. Results: Megaloblastic anaemia was the commonest diagnosis followed by acute leukemia, nutritional anaemia, chronic leukemia, multiple myeloma, leukemia/lymphoma syndrome, and essential thrombocythemia. In case of dry aspirate or diluted marrow biopsy was useful to diagnose aplastic anemia, and secondary myelofibrosis associated with acute and chronic leukemia, multiple myeloma, leukemia/lymphoma syndrome and myelomonocytic leukemia. Aspirate and imprint smears were better for cellular morphology. Conclusion: Aspiration and imprint smears give better morphological details/cytologic diagnosis. In dry tap or diluted marrow, biopsy was more helpful in identifying architectural pattern, cellularity and fibrosis whereas imprint smears were more helpful for cellular morphology. BMA, BMI and BMB are complimentary to each other.

Lomustine chemotherapy for the treatment of presumptive haemophagocytic histiocytic sarcoma in Flat‐coated Retrievers

The Flat-coated Retriever (FCR) is a breed at-risk for histiocytic sarcoma (HS). A haemophagocytic form of HS (HPHS) occurs in the spleen ± other sites such as bone marrow, and is a CD11d+ disease of macrophage origin. Patients with HPHS typically present with regenerative anaemia. Lomustine is a well-accepted, first-line chemotherapy for dogs with HS, but its specific utility in dogs with HPHS has not been previously reported. A cohort of 10 dogs presumptively diagnosed with HPHS via splenic ± bone marrow or liver aspiration cytology were treated with lomustine, plus supportive medications as required. Cytology of liver and bone marrow was diagnostically useful in patients where splenic cytology was less convincing. No dogs experienced significant constitutional or gastrointestinal adverse effects following lomustine administration, though most dogs displayed clinical signs associated with the underlying disease. No patients appeared to derive discernible clinical benefit from chemotherapy. Neutropenia was a common adverse effect of lomustine. Concurrent medications included corticosteroids in all cases, prior to the diagnosis of HPHS, for a provisional diagnosis of immune-mediated haemolytic anaemia. Median survival time of the treated dogs was 24 days from diagnosis (range, 4-67 days). HPHS affecting FCRs appears to have a uniformly poor outcome and is rapidly fatal. Lomustine chemotherapy was unsuccessful in significantly improving outcome in this cohort of patients. Further study of this rare and devastating disease is needed.