Indications For Bone Marrow Examination Research Articles

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.

Diagnostic performance of automated red cell parameters in predicting bone marrow iron stores.

The aim of the study was to determine the diagnostic performance of novel automated red cell parameters for estimating bone marrow iron stores. The study was a retrospective single-centre study based on data from an automated haematology analyser and results of bone marrow iron staining. Red cell parameters were measured on a Sysmex XN-series haematology analyser. Bone marrow iron stores were assessed semiquantitatively bycytochemical reaction according to Perls. The analysis included 429 bone marrow aspirate smears from 393 patients. Median age of patients was 67 years, 52 % of them were female. The most common indication for bone marrow examination was a plasma cell dyscrasia (n=104; 24 %). Median values of percentage of hypochromic and hyperchromic red blood cells (%HYPO-He, %HYPER-He), reticulocyte haemoglobin equivalent (RET-He) and microcytic red blood cells (MicroR) were statistically significantly different between cases with iron deplete and iron replete bone marrow. In a logistic regression model, ferritin was the best predictor of bone marrow iron stores (AUC=0.891), outperforming RET-He and %HYPER-He (AUC=0.736 and AUC=0.722, respectively). In a combined model, ferritin/MicroR index achieved the highest diagnostic accuracy (AUC=0.915), outperforming sTfR/log ferritin index (AUC=0.855). While single automated red cell parameters did not show improved diagnostic accuracy when compared to traditional iron biomarkers, a novel index ferritin/MicroR has the potential to outperform ferritin and sTfR/log ferritin index for predicting bone marrow iron stores. Further research is needed for interpretation and implementation of novel parameters and indices, especially in the context of unexplained anaemia and myelodysplastic syndromes.

Diagnostic Evaluation of Haematological Diseases Based on Bone Marrow Examination

Background: Bone marrow examination is a safe invasive procedure and can provide sufficient explanation for unexplained cytopenias, leukaemia and other haematological disorders including metastases to the marrow by detailed morphological description of the marrow elements. Objective: To see the importance of bone marrow examination for the diagnosis of haematological disorders. Materials and Methods: It was a descriptive cross-sectional study comprising 196 patients who underwent bone marrow examination for evaluation of haematological disorders in the Department of Haematology, Enam Medical College and Hospital during the period of July 2012 to December 2019. Results: Total number of cases were 196, male to female ratio was 1.56:1 and majority of the patients were >18 years of age (84.69%). Common indications for bone marrow examination were pancytopenia (33.67%) and diagnosis of leukaemia/ myeloproliferative neoplasm (23.98%). In our study, haematological conditions were 79.08%. Among these malignant conditions were 55.10% and nonmalignant conditions were 23.98%. Aplastic anaemia (14.29%) and immune thrombocytopenia (7.65%) were the most common nonmalignant disorders. Common malignant disorders were acute myelogenous leukaemia (20.41%) and multiple myeloma (9.69%). Conclusion: Bone marrow examination is a simple and effective procedure in reaching the final diagnosis of haematological diseases. J Enam Med Col 2021; 11(1): 34-38

Spectrum of Haematological & Non Haematological Disorder Diagnosed by Bone Marrow Examination: A Study of 115 Cases

Introduction: Haematological and nonhaematological diseases affecting the bone marrow may be primarily or a secondarily spread to the marrow. In most of the cases, diagnosis can be arrived at by a detailed history, physical examination and few simple investigations. Bone marrow examination is a very useful tool in the diagnosis of hematological and non-hematological diseases. Materials and Methods: This retrospective study was done in the department of haematology, in a specialized diagnostic centre from July 2018 to July 2021. A total of 115 cases were included in this study. Clinical parameters were assessed, peripheral blood smear along with necessary haematological investigations were done. Results: Majority patient were male (70%). In total cases 44.4% patients were under 30 years of age. Among them 23(20%) were under 10 years. The most common indication for bone marrow examination was diagnosis & management of Acute Leukaemia 27(23.48%), Major presenting complaints were fever 49(42.61%), fatigue 46(40.0%) & bleeding manifestation 22(19.13%). On systemic examination, pallor was found in majority of the cases. Hematological malignancies were found in 77(66.96%) cases, non-malignant haematological disorders were found in 33(28.70%) cases. Acute leukaemic condition (ALL, AML) were the most common malignant conditions, 22(19.13%) & 17(14.78%) respectively. Most common nonmalignant haematological conditions were hypocellular marrow 17(14.78%). Conclusion: Acute Leukemia is a major indication of BME. Among the pathological condition malignant condition are commonly seen. And male are predominantly suffering more from haematological disorders than female. In majority cases acute leukaemic condition are seen in BME. Medicine Today 2022 Vol.34(1): 7-11

Indications and diagnostic value of bone marrow examination in HIV-positive individuals: A 3-year review at Tygerberg Hospital.

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.

Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007\u20132015

BackgroundMalaria is a life-threatening, multisystem disease caused by the plasmodial parasite with a global incidence of approximately 229 million annually. The parasites are known to have unique and crucial interactions with various body tissues during its life cycle, notably the liver, spleen, and recent work has shown the bone marrow to be a reservoir of infection.MethodsThis study is a case series of patients in whom examination of bone marrow revealed malarial parasites. A retrospective record review of 35 parasite-positive bone marrow specimens examined at Aga Khan University Hospital (AKUH), Karachi, Pakistan, over the years 2007 to 2015 was conducted. Bone marrow aspirates were collected as per International Council for Standardization in Haematology (ICSH) guidelines.ResultsThe median age of patients was 22 years (range 1–75), and 60 % (n = 21) were male. 22 patients had evidence of Plasmodium falciparum, 12 had evidence of Plasmodium vivax and 1 patient had a mixed infection. Gametocytes and trophozoites were the most common stages identified on both peripheral blood and bone marrow examinations. Indications for bone marrow examination included fever of unknown origin and the workup of cytopenias and malignancies.ConclusionsThe incidental finding of Plasmodium in samples of bone marrow suggests the reticuloendothelial system may be regularly harbour these parasites, be the infection acute or chronic in character.

HAEMATOLOGICAL DISORDERS DIAGNOSED IN ONE HUNDRED AND ONE SUCCESSIVE BONE MARROW EXAMINATION AT A TERTIARY CARE CENTRE IN QUETTA, BALOCHISTAN

Objective: To determine the frequency of haematological disorders diagnosed by bone marrow examination at a tertiary care centre in Quetta, Balochistan.
 Study Design: Prospective observational study.
 Place and Duration of Study: Department of Pathology, Combined Military Hospital Quetta, from Jan 2018 to May 2019.
 Methodology: A total of 101 one patients, who underwent bone marrow examination, were included in the study. Brief history, clinical examination and indication of procedure were also endorsed in a questionnaire designed for the study.
 Results: Bone marrow of one hundred and one patients, included in the study, were evaluated. Mean age of the patients was 32.3 ± 18.4 years. There were 68 males (67%), while 33 were females (33%) with 2:1 male to female ratio. Pyrexia of unknown origin (PUO) was the most common indication for bone marrow examination with frequency of 20.7%. Nutritional anaemia was the most prevalent benign disorder (17%), whereas Acute Lymphoblastic leukaemia (ALL) accounted about 6.8% which is highest in malignant disorders.
 Conclusion: This study has concluded that bone marrow examination is a useful technique and findings of bone marrow can modify the treatment. Thus procedure has a great diagnostic value. Both bone marrow aspiration (BMA) and bone marrow biopsy (BMB) are the complimentary techniques and supremacy of one method on other depends on the disorder.

Utility of Bone Marrow Examination in the Diagnosis of Splenomegaly: Experience from a Tertiary Care Center

Introduction: Establishing the diagnosis of splenomegaly is a clinical and pathological conundrum. The present study aimed to evaluate the clinicohematological findings and the significance of bone marrow examination in establishing the etiology of splenomegaly. Materials and Methods: This study was a retrospective analysis of patients with splenomegaly who had indications for bone marrow examination. The study was conducted over a period of 2 years. Detailed hematological and serological investigations were analyzed in those patients. Results: There were 96 males and 60 females. Most of the patients presented with fever. A mild degree of splenomegaly was found in 56.4% of the patients, followed by moderate (39.7%), and massive (3.9%) degree of splenomegaly. Pancytopenia was noted in 15.4% of the patients. Anemia was observed in 96.2% of the cases. Erythroid hyperplasia was the most common bone marrow finding (37.2%). Etiologies of splenomegaly were documented by the clinico-laboratory evaluation in 45.5% of the patients. Bone marrow examination along with peripheral blood examination alone established etiologies in 15.4% of the patients. Conclusion: Anemia and hematological malignancies formed a major part of the etiologies of splenomegaly. Bone marrow examination was an inevitable investigation in these situations. Serological investigations were useful in the diagnosis of nutrition deficiency anemia and infectious etiology. The grade of splenomegaly assessed clinically at the time of presentation provided an important clue for the etiology. Bone marrow examination proved to be an important diagnostic tool in the workup of patients with splenomegaly.

Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa.

BackgroundBone marrow aspiration and trephine biopsy (BMAT) are widely performed in adults to evaluate haematological and malignant conditions. However, the diagnostic yield from the procedure in unselected patients in the South African public sector has not previously been described.ObjectivesWe identified the main indications and most common diagnoses encountered for BMAT and described the demographic and blood profiles of patients, including HIV-positive patients, who had undergone the procedure at a tertiary hospital in KwaZulu-Natal.MethodsWe retrospectively reviewed laboratory data from January 2016 to December 2016 for all patients aged ≥ 13 years who underwent the procedure and stratified findings by demographic data.ResultsAmong 120 BMAT biopsies studied, 80 (67%) cases were performed to evaluate suspected malignancy and a further 40 (33%) cases for non-malignant indications. The main indications for bone marrow examination were: cytopenias 38 (32%), lymphoma 35 (29%), leukaemia 21 (18%), and multiple myeloma 17 (14%). BMAT results revealed that 60 cases (50%) were malignant in origin, 30 cases (25%) were non-malignant and 30 cases (25%) were classified as normal. The common diagnoses were: leukaemia, 24 (20%); multiple myeloma, 16 (13%) and lymphoma, 13 (11%). Cases aged ≥ 50 years were more likely to have a malignant diagnosis (odds ratio: 5.8 (95% confidence interval: 2.2–17.1) p-value < 0.001).ConclusionThe diagnostic yield of BMAT was high, with significant abnormalities detected in three quarters of cases. Haematological malignancy was the more common diagnosis. Increasing age was associated with an increase in reporting of haematology malignancy.

BONE MARROW STUDY IN CASES OF HAEMATOLOGICAL DISORDERS

Introduction: There are various disorders in formation of blood in body. Bone marrow is one of them which involved variety of hematological and nonhematological disorders. Hematological disorders include myeloproliferative neoplasm (MPN), acute leukemia, hemato-lymphoid neoplasm and nutritional deficiency diseases whereas nonhematological disorders include infectious diseases infiltrating the bone marrow such as parasitic infections, tuberculosis and metastatic deposits. Bone marrows present various diseases with various clinical symptoms with the involvement of blood but peripheral blood picture alone does not reflect the nature of disease process. Depending upon the suspected diagnosis from clinical features and peripheral blood examination, that indication for bone marrow examination can be done. Examination of Bone marrow is useful in the diagnosis of both hematological and non-hematological disorders. The most important techniques used for the diagnosis of hematological disorders are trephine biopsy and bone marrow aspiration. For the interpretation of the disorder of bone marrow history, clinical finding, peripheral blood picture and other laboratory findings are required. Usually Bone marrow aspiration (BMA) alone is sufficient for the diagnosis of nutritional anaemias, most of the acute leukaemias and Immune thrombocytopenias. Diagnosis such as Trephine biopsy provides important diagnostic information myelofibrosis, granulomatous disease and bone marrow infiltration. Bone marrow aspiration is useful in making out better individual cell morphology whereas biopsy is useful in bone marrow architectural pattern and distribution. Bone marrow is nor mocellular or hypercellula resulting from ineffective hematopoiesis, increased peripheral destruction and bone marrow invasion. Therefore, bone marrow examination is extremely helpful to identify the cause of pancytopenia.&#x0D; Aim: The main aim of this study is to evaluate the cytological and histological pattern of various hematological disorders in bone marrow aspiration and trephine biopsy respectively.&#x0D; Material and Methods: During the period of 1 year 100 patient with the cases of haematological disorders were included in this study. Routinely stain like Leishman stain is used for bone marrow aspiration. Haematoxylin and eosin stain is also used for trephine biopsy. For all the cases reticulocyte count, peripheral smears, sickling test and complete hemogram were done. Special stains PAS Stain (Periodic acid schiff) was done for all ALL, AML and gauchers disease. In ALL cases Block positivity is shown. In gauchers disease, a gaucher cell shows wrinkled tissue paper appearance with PAS positivity. Reticulin stain was done in myelofibrosis and metastatic deposits. In myelofibrosis, trephine biopsy shows increase in reticulin network with coarse fibrils.&#x0D; Result: In all the cases bone marrow aspiration was done and among them 40 cases trephine biopsy were done. Out of total patients 57 were male and 43 were female. And the mean age was found as 32.6 years. The findings of the bone marrow were examination. At the time of study period 50% of the study have anemias and they are predominantly megaloblastic followed by aplastic/ hypoplastic anemias. Other three cases include two metastatic deposits and one storage disorder (Gaucher’s Disease).&#x0D; Conclusion: Bone marrow examination is important to diagnosis, prognosis or evaluate therapeutic response for a variety of hematologic and non-hematologic problems. Nowadays, Bone marrow aspiration &amp; bone marrow biopsy are used routinely as diagnostic procedures because it is easier and does not require advance equipments. Therefore both the procedures are complementary to each other which are helpful in further investigation and management.&#x0D; Keywords: Bone marrow aspiration, Trephine biopsy, Pancytopenia, Megaloblastic Anemia

Study of haematological disorders detected by bone marrow examination at tertiary care hospital

Bone marrow aspiration & biopsy examination is often required for diagnosis & management of haematological disorders which have diverse modes of presentation. Mostly of the haematological disorders present as anaemia, which are diagnosed by bone marrow aspiration (BMA) and bone marrow biopsy (BMB). I n the department of pathology, the study was conducted to compare the role of bone marrow aspirate and trephine biopsy for diagnosing the haematological diseases and indications. Materials and Methods: To check the role of bone marrow aspiration and biopsy in the diagnosis of haematological disorders this is the aim of study. In the department of pathology at tertiary care teaching hospital this study was conducted over a period of 2 years from November 2016 to October 2018. A total of 572 cases were included in this study. Results: In the present study, both aspiration and biopsy cases were available are 572 were included. The age ranged from 6 months to 84 years. The 326(56.99%) were males and 246(43%) were females with M: F=1.32 :1. Clinical indications for bone-marrow examination, The most common indication was pancytopenia of 201 cases (35.13%) followed by anaemia 167 cases (29.19%), malignancy 79 cases (13.81%), Hepatosplenomegaly 48 cases (8.39%), thrombocytopenia 47 cases (8.21%) and fever 30 cases (5.24 %). Most of the cases had hypercellular bone marrow (53%) followed by normocellular marrow (32%) and hypocellular marrow (15%). Keywords: Bone marrow, Biopsy, Examination, Haematological disorders.

Diagnostic Role of Bone Marrow Examination in Detecting Haematological and Nonhaematological Disorders

Introduction: Bone marrow study has wide application in clinical medicine. It is important test not only for diagnosis of haematological diseases but also for various systemic illnesses. The aim of this study is to determine the indications, the spectrum of haemotological and non haematological disorders diagnosed by using this procedure.&#x0D; Materials &amp; Methods: It was a prospective study comprising 152 patients who underwent bone marrow examination for evaluation of haematological and nonhaematological disorders in the Department of Haematology, Enam Medical College Hospital during the period of 2012 to 2017.&#x0D; Results: In our study male to female ratio was 1.6:1 and common age group was &gt;45years (n-65, 42.76%). Most common indications for bone marrow examination were pancytopenia (26.97%, n-41) and diagnosis of leukaemia/myeloproliferative neoplasm (25.66%, n-38). 90.13% (n-137) marrows were pathological. Non-malignant conditions were 40.79% (n-62) and malignant conditions were 49.43% (n-75). Non malignant haematological condition were 33.55% (n-51), malignant haematological conditions were 47.37% (n-72). Most common nonmalignant haematological conditions were aplastic anaemia (15.13%, n-23) and immune thrombocytopenic purpura (9.87%, n-15). Visceral leishmaniasis was found 3.29% (n-5). Acute myelogenous leukaemia (14.47%, n-22) and multiple myloma (11.18%, n-17) were the most common malignant haematological condition. Secondary deposit was found 1.97% (n-3).&#x0D; Conclusion: Bone marrow examination is a simple invasive procedure for diagnosis of both haematological and nonhaematological diseases when routine investigations failed to reach the final diagnosis.&#x0D; Medicine Today 2019 Vol.31(1): 15-18

Increased Multinucleated Megakaryocytes as an Isolated Finding in Bone Marrow: A Rare Finding and Its Clinical Significance.

Multinucleated megakaryocytes are a unique morphologic form of megakaryocytes characterized by multiple, distinctly separated nuclei. We investigated whether increased multinucleated megakaryocytes (≥25%) in otherwise normal-appearing bone marrow were associated with the development of a myelodysplastic syndrome (MDS). We retrospectively reviewed the medical records and bone marrow biopsy specimens of patients evaluated at our institution from 2011 to 2015 that met all of the following criteria: (1) 25% or more multinucleated megakaryocytes, (2) no other dysplastic features, (3) absence of a myeloid neoplasm, and (4) absence of neoplastic karyotypic abnormalities. Nine cases of 19,885 bone marrow biopsy specimens were identified. The indications for bone marrow examination included plasma cell neoplasm, lymphoma, and cytopenia(s). All patients had anemia at the time the multinucleated megakaryocytes were found. No patients had thrombocytopenia or neoplastic karyotypic abnormalities. Follow-up was available for seven patients with a median of 27 months (range, 7-53 months). No patients developed progressive cytopenias or MDS. Multinucleated megakaryocytes (≥25%) as an isolated finding in the bone marrow are a rare phenomenon. These patients do not appear to be at increased risk of developing progressive cytopenia(s) or MDS. Caution should be taken to not overdiagnose these cases as MDS.

Bone Marrow Examination in Cases of New-onset Pancytopenia: A Four-year Study from a Medical College in the Rural Hilly Setting of Western Himalayas, India

New-onset pancytopenia is a common diagnostic challenge. Pancytopenia is an indication for bone marrow examination. The present study has been carried out to determine the frequencies of various etiologies of pancytopenia based on bone marrow morphology in a defined geographical location. All cases of new-onset pancytopenia, diagnosed on peripheral smear and seen over a four-year period from January 2012 to December 2015 in the department of pathology, were analysed. Patients lacking representative bone marrow in the aspirate or receiving chemotherapy were excluded. Out of 69 cases, 29 were males and 40 were females. Most of the patients were in the age group of 19-60 years (52.2%). Nineteen (26.1%) of them were less than 18 years old. The three major causes of pancytopenia were: megaloblastic anemia (hypercellular marrow with megaloblastic erythropoiesis) in 25 (36.2%) cases, hypercellular marrow with dimorphic erythropoiesis in 13 (18.8%) cases, and haematological malignancies in 12 (17.4%) cases of the study. Bone marrow examination along with laboratory evaluation helps to establish specific diagnosis in cases of new-onset pancytopenia.

Hepatitis C among Egyptian Patients Referred for Bone Marrow Examination: Seroprevalence and Analysis of Hematological Findings.

Hepatitis C is a significant public health problem in Egypt where the highest prevalence (14.7%) of hepatitis C virus (HCV) exists. HCV prevalence is even higher among clinical populations and groups at risk of exposure to infection. Chronic HCV infection is associated with several hematological complications that may necessitate bone marrow (BM) examination. The aim of this study is to estimate HCV prevalence among patients referred for BM examination and to explore hematological and BM findings among HCV positive patients. One hundred adult patients referred for BM examination were included in the study and screened for HCV antibodies. Patients' clinical, hematological, and BM findings were recorded. The seroprevalence of HCV among patients referred for BM examination was 42%. The most common indication for BM examination among HCV positive patients was peripheral cytopenias (88.1%). The most common cytopenia detected was thrombocytopenia (85.7%). The most common diagnosis among HCV positive patients was hypersplenism (52.4%) followed by B-lymphoproliferative disorders (19%) and then immune thrombocytopenic purpura (11.9%). In conclusion, HCV prevalence among patients referred for BM examination is higher than that estimated in the general population. Patients with unexplained peripheral cytopenias should be tested for HCV.

Diagnostic Value of Bone Marrow Aspiration and Biopsy in Routine Hematology Practice

The bone marrow is frequently involved in variety of cases presenting with hematological and non-hematological disorders, which are diagnosed by two separate but interrelated techniques such as bone marrow aspiration (BMA) and bone marrow biopsy (BMB). This study was aimed to assess the diagnostic value of the BMA and BMB and role of both the procedures to reach final diagnosis when done simultaneously. It was a prospective study. The findings of BMA smears were correlated with BMB sections and data obtained was analysed. BMA and BMB were performed on 50 patients. Criteria of inclusion included the main indications for performing this procedure, the availability of full medical records and patient consent. The patients had a male to female sex ratio of 1.6:1 and a wide age range from 4 years to 74 years. In the present study, the main indications for bone marrow examination were categorized. Out of 50 cases studied, in 23 cases, a strong positive correlation between BMA and BMB was noted. However, it was found that in the cases of aplastic anaemia, different phases of myeloproliferative neoplasm (MPN), multiple myeloma, tubercular granulomas and hemato-lymphoid neoplasm, involvement of the marrow was detected better in bone marrow biopsies. The study concludes that preparations of aspirate and trephine biopsy are easy, rapid and complementary to each other in majority of the lesions. The advantage of both the procedures done together enabled us to study the cytomorphology of the cells along with the pattern of distribution of the cells depending on the cases, hence help in making the diagnosis accurately.

Clinicohematologic analysis of pancytopenia: Study in a tertiary care centre

Background and aim: A study was carried out to analyze the presentation, to identify the causes and to find out the bone marrow morphology in cases of pancytopenia. Pancytopenia was an indication for bone marrow examination in 48 out of a total of 100 cases (48%) for which a bone marrow examination was requested. Methods: The data regarding the various signs and symptoms, the causes and the bone marrow findings were obtained and analyzed using simple statistical methods. All age groups were included for the study. Results: Generalized weakness (70.83%) was the commonest symptom and pallor (45.83%) was the predominant sign. Anisocytosis (79.1%) was the most important peripheral blood finding in pancytopenic patients followed by microcytosis (52.08%). The commonest cause of pancytopenia in the present study was hypoplastic marrow (33.33%), followed by normoblastic erythroid hyperplasia (27.08%), megaloblastic marrow (18.75%), and myelodysplastic syndrome (8.33%). Normal bone marrow and dry tap accounted for three cases each (6.25%). Of the various cases of myelodysplastic syndrome, one was refractory anemia; two were refractory cytopenia with multilineage dysplasia and one myelodysplastic syndrome unclassified. Dry tap was seen in three cases of pancytopenia. Bone marrow biopsy was done in one, which showed features of myelofibrosis. Conclusions: A thorough evaluation of the pancytopenic patients is necessary as it has varied causes.

Bone marrow examination findings at Aga Khan University Hospital, Nairobi

To establish the bone marrow examination findings and determine the indication for bone marrow examination. A retrospective audit. Aga Khan University Hospital, Nairobi. All bone marrow aspirates done at Aga Khan University for the period comprising February 2003 to February 2006 were retrieved and analysed. A total of 356 patient's case histories including bone marrow examination results were analysed. Ages of the patients ranged from 18 months to 91 years. Males were 180 (50.6%) and females were 176 (49.4%). Nutritional anaemia as a group was the most common haematological disorder found on bone marrow examination in our patients with megaloblastic anaemia predominating. Acute myeloid leukaemia was the most common malignant haematological disorder. The most common indication for bone marrow examination was anaemia followed by diagnostic work up of fever of unknown origin. Nutritional anaemia predominated as the commonest benign haematological finding on bone marrow examination while acute myeloid leukaemia was the most frequent haematological malignancy. Most bone marrow examinations were performed on patients with anaemia.

Indications and Diagnostic Utility of Bone Marrow Examination in Different Bone Marrow Disorders in Iran

The shortage of published literature regarding the indications for bone marrow examination and the prevalence of hematologic disorders in the Middle East, especially Iran, prompted us to review 1154 bone marrow specimens sent to the Pathology Department of Rasoul Akram Hospital in Tehran from January 2002 to December 2006. We aimed to determine the diagnostic utility of the bone marrow examination for different bone marrow disorders by determining the clinical suspicion and indications for bone marrow examination for each patient and comparing these findings with the final pathologic diagnoses. The patients comprised 657 males and 497 females, with ages ranging from 1 to 95 years. The most frequent indication was pancytopenia, followed by suspicion of multiple myeloma, lymphoma, and follow-up of leukemia. After exclusion of 110 unsatisfactory and 416 normocellular specimens, the total number of bone marrow disorders was 628 (170 of reactive bone marrow and 458 of nonreactive marrow). Acute leukemia and plasma cell dyscrasia were the 2 most common new diagnoses among nonreactive marrows. In conclusion, bone marrow examination had the highest diagnostic yield with respect to suspicion of leukemia (54%), multiple myeloma (30.3%), myeloproliferative disorders (25%), and lymphoma (16.2%), and it was the least helpful in suspected cases of storage disorders (0%) and infection (2.2%).

Die Rationale für Knochenmarkuntersuchungen bei Patienten mit entzündlich-rheumatischen Erkrankungen

Inflammatory rheumatic diseases and the applied immunosuppressive treatments can lead to bone marrow depressions and promote hematologic malignancies. Our objective was to explore indications for and results of bone marrow examinations in a large cohort. Between 1990 and 2004 146 bone marrow examinations in 3638 patients were performed due to abnormal laboratory results. Medical history, results of bone marrow examination (morphology, histology) and cytogenetic data were investigated retrospectively. Patients' (67.8% female) mean age at bone marrow examination was 53.5 years (SD 15.5), median disease duration 2.9 years. Indications for bone marrow examination were changes in peripheral blood counts in 81.7%. In 52 patients (35.6%) clinically relevant, partially neoplastic bone marrow changes (5 non-Hodgkin lymphoma, 9 myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML) and 3 myeloproliferative neoplasias) were evident. Medication history showed intake of hydroxy-/chloroquine (13.5%), methotrexate (17.3%), cyclosporin (7.7%), sulfasalazine (7.7%), mycophenolatmofetil, gold, leflunomide (each 1.9%), azathioprine (aza, 25.0%) or cyclophosphamide (cyc, 7.7%) prior to bone marrow examination. 7 out of 9 patients, who developed MDS/AML had been treated with either azathioprine alone or additionally with cyclophosphamide (n = 3). One third of our patients showed relevant bone marrow changes that might be associated to therapy. The risk seems to be increased especially in patients with inflammatory rheumatic diseases who had received azathioprine alone or in combination with cyclophosphamide. Health care providers should bear in mind the risk of hematologic malignancies and monitor patients closely in this respect. Bone marrow examination should be performed in case of changes in peripheral blood counts; especially clinically relevant anemia, granulocytes < 2,500/microl, thrombocytes < 100,000/microl and relevant changes over time should lead to bone marrow examinations.