Adequacy of Bone Marrow Trephine Biopsy in a Tertiary Care Center

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4702-4702 ◽  
Author(s):  
Emily K Rimmer ◽  
Donald S Houston ◽  
Kristine Roland
Keyword(s):  
Bone Marrow ◽  
Medical Students ◽  
Tertiary Care ◽  
Health Sciences ◽  
Bone Marrow Biopsies ◽  
Bone Marrow Trephine ◽  
Total Length ◽  
Significant Difference ◽  
Cancer Clinic

Abstract OBJECTIVES: To review the bone marrow trephine biopsies analyzed at the Health Sciences Centre in Winnipeg, Canada in 2007 and evaluate them in terms of published criteria for adequacy. METHODS: The Health Sciences Centre (HSC) is the largest tertiary care centre in the province of Manitoba, and houses the only leukemia treatment/bone marrow transplant ward. It also provides pathology services to the adjacent clinics of the provincial cancer agency. One thousand and twelve (1012) bone marrow aspirates and biopsies were identified from January 1 – December 31, 2007 through pathology records. Bone marrow biopsies performed on children (age <18 years) and specimens referred from other centers were excluded. A total of 770 bone marrow aspirates and biopsies were identified as meeting the inclusion criteria and 67 were unavailable for evaluation. 703 biopsies were included in the final analysis. Data was collected on location of procedure (HSC ward vs. outpatient cancer clinic), operator and indication of biopsy. The total length of each biopsy and length of interpretable bone marrow were measured. The bone marrow biopsies were compared to published criteria for adequacy: 16 mm total length prior to processing (11 mm after processing), and 8 mm of interpretable marrow after processing. RESULTS: Using 8 mm of interpretable marrow as the criterion of adequacy, the overall adequacy rate was 67% (472/703). There was a significant difference in the percentage of adequate biopsies between operators. Hematologists obtained an adequacy rate of 81% (220/272), Registered Clinical Assistants (RCA) 63% (169/268), oncologists 56% (5/9), residents 50% (71/141), and medical students 54% (7/13), p<0.001). The mean overall length of biopsy after processing was 14.5 mm (SD 5.3 mm), with 10 mm (SD 5.4 mm) of interpretable bone marrow. Hematologists obtained samples with a mean length of interpretable bone marrow of 12.4 mm (SD 5.8 mm), RCA 8.6 mm (SD 3.9 mm), oncologists 10 mm (SD 4.1 mm), residents 8.4 mm (SD 5.7 mm), and medical students 8.2 mm (SD 4.5 mm). There is a significant difference in length of core biopsies obtained by different operators. Hematologists get longer biopsies than residents (p≪0.01), RCA (p≪0.01) and medical students (p<0.05). When looking specifically at those cases (n = 294) in which the requisition submitted at the time of the procedure stated an indication for which an adequate biopsy is crucial (detection of infiltration, diagnosis and staging of lymphoma) or when there was an inadequate/dry aspirate (n = 74), there was no significant difference in percentage of adequate biopsies when compared to the overall adequacy rate (70% vs. 67%, p=NS). When the biopsy was performed at the outpatient cancer clinic, the adequacy rate was 72.5% (342/472), whereas biopsies performed on HSC wards had an adequacy rate of 56.4% (133/236). CONCLUSIONS: A large proportion of bone marrow biopsies performed during the study period were of inadequate size. There was a significant difference in quality of bone marrow biopsies obtained by different operators, and among biopsies performed at different locations. The proportion of adequate samples was no better in cases where the aspirate was dry or where the suspected diagnosis should have mandated collection of an adequate sample. A multidimensional intervention including education and procedural changes will be implemented in order to improve the quality of bone marrow biopsies performed.

Abstract P546: Sleep Quality in Medical Students A Cross-sectional Study

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lilian S Costa ◽  
Marina C Marins ◽  
Jocasta C Ansel ◽  
Carolina P Tavares ◽  
Fernanda T Queiroz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Students ◽  
Female Gender ◽  
Cross Sectional Study ◽  
Female Group ◽  
Sleep Habits ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Hours

Introduction: Medical students, susceptible to sleep disorders, have irregular sleep-awake cycle, with repercussions on the quality of life and reduced academic performance, often with greater incidence of psychiatric disorders, estimated at 15% to 25% during your academic training. Objective: To evaluate the sleep habits in students of medical school in a private college of Rio de Janeiro, Brazil. Method: This subset study is a part of an observational study with cross-sectional delineation, with data collected through the application of an anonymous questionnaire, where they were asked about the number (and modification) of hours they sleep daily, in addition to reports of “stress and anxiety”. These data collected formed the basis of an instrument for assessing the quality of life on the medical students of this College. Results: We analyzed data from 481 students: 82 (17%) at the first year, 118 (24.5%) at the second year, 99 (20.6%) at the third, 64 (13.3%) and 118 (24.5%) within the fifth and sixth years. The average age was 21.7 years (16-42) and 306 (63.6%) of female gender. As for the hours of sleep, 445 students (92.5%) report 5 to 8 hours of sleep, and 216 (44.9%) a minimum of 6 hours. In the sleep of the weekends, 394 (81.9%) reported change in the number of hours and, 313 (65.1%) referred to a reduction after the entrance into college. It was reported "some level of stress and anxiety,“ not related to the least number of hours sleepping (0.07). Comparing the data obtained among the 199 students of the first and second years (62.8% female-group A) to 117 at fifth and sixth years (70.9% female-group B), we observed similarity in relation to (1) number of 5 to 8 hours sleepping (A 92.9% x 90.5% B), (2) change the hours of sleepping on the weekends (A 81.9% x 79.5% B), and (3) reduction of sleepping hours after the entrance into College (A 81.9% x 78.6% B). With regard to the report of "stress and anxiety”, we observed statistically significant difference between the groups (A 100% x 88% B, p < 0.03). Conclusion: The change in lifestyle imposed on joining a new school learning model, generates anxiety and loss of sleep hours among students. The development of resilience and adaptation to change, both individual and institutional, may have been responsible to varying degrees of stress.

scholarly journals The Severity of Fatigue Among Bone Marrow Transplantation Patients

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 99s-99s
Author(s):  
O. Abdalrahman ◽  
E. Almashaikh ◽  
H. Aljarrah
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Cancer Patients ◽  
Subscale Score ◽  
Medical Intervention ◽  
Significant Difference ◽  
Fatigue Severity ◽  
Male Patients

Background: Fatigue interferes with the individual´s functioning and quality of life in cancer patients specifically, after chemotherapy and post–bone marrow transplantation (BMT), fatigue is not adequately addressed and prioritized among health care providers. Aim: The purpose of this study is to determine the severity and prevalence of fatigue among cancer patients post-BMT after receiving chemotherapy. Methods: A descriptive, cross-sectional and correlational design was used, Piper fatigue scale (PFS) Arabic version was used to measure participants' level of fatigue, the scale measures four dimensions of subjective fatigue: behavioral, affective, sensory, and cognitive. Patients above 18 years old, received chemotherapy and do BMT between Oct 2016 and Oct 2017, were included in this study. Results: 100 patient participated in this study, 52% (N: 52) diagnosed with leukemia, 32% (N: 32) lymphoma, and 16% (N: 16) hematology. Thirty-nine patients (39%) had no or mild fatigue level, they do not need medical intervention, 47% (N: 47) and 14% (N: 14) classified as moderate and sever level of fatigue respectively, equal to 61% of the total sample who need medical intervention. Overall fatigue severity categories; mild, moderate, and sever shows that there is significant difference in term of severity subscale in sensory and behavioral dimensions ( P = 0.03, 0.004) respectively, and the other subscale dimension did not significantly differ among patient ( P > 0.05), the highest mean subscale score occurred in the behavioral dimension (M = 4.8, SD = 2.37), while the lowest mean subscale score occurred in cognitive dimension, (M=2.59, SD=2.35). The overall score mean of the male patients regarding the fatigue severity was 45.18 (n=74), and for the female patients the mean was 57.03 (n=26), and the result shows that there was significant difference in the overall mean scores between male patients and female patients (t (98)= −2.2, P < 0.05). Conclusion: Fatigue-related to BMT is a serious and prevalent problem among patients with cancer. Fatigue may impair quality of life among this group of patients; further study may be conducted to assess the effect of fatigue on quality of life and activity of daily living. It is essential to include fatigue assessment as a priority for the BMT patients.

Complementary therapies in controlling side-effects during cancer treatment

2021 ◽  
Vol 9 (7) ◽  
pp. 238-265
Author(s):  
Vinicius Teixeira Botelho ◽  
MELINE ROSSETTO RODRIGUES ◽  
Guilherme Augusto Rago Ferraz ◽  
Cassiana Mendes Bertoncello Fontes ◽  
Maria Helena Borgato ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Side Effects ◽  
Randomized Clinical Trials ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Of Bias ◽  
Anxiety Control ◽  
Significant Difference

This systematic review evaluated whether reiki had an impact on patients undergoing chemo-therapy, with possible improvement of the following outcomes: fatigue, pain, anxiety and quality of life. Method: Systematic review study with meta-analysis conducted at a tertiary care center. The following databases were searched until July 2020: MEDLINE, LILACS and CENTRAL. Two re-viewers independently examined eligible articles, extracted data and assessed the risk of bias using the Cochrane tool. Results: The analyzes included eight studies and showed that there was a sta-tistically significant for anxiety control (MD = -2-09; 95% CI: -3.00 to -1.19; I2 = 51%) and Quality of life (MD = -5.97; 95% CI: -10.70 to -1.25; I2 = 97%) but no statistically significant difference was found for the other outcomes analyzed. An analysis of the risk of bias has uncertain methodological limitations in the studies. Conclusions: Although there is anxiety control and improved quality of life, there is a need for the elaboration of randomized clinical trials with larger populations to verify their real performance in controlling some side effects during chemotherapy.

Does Teaching Clinical Ethics to Medical Students Improve Knowledge, Attitude, and Practice of Medical Ethics Among Clinicians? An Observational Study in a Tertiary Care Hospital in Nepal.

2020 ◽  
Author(s):  
Carmina Shrestha ◽  
Jasmin Joshi ◽  
Ashma Shrestha ◽  
Shuvechchha Karki ◽  
Sajan Acharya ◽  
...  
Keyword(s):  
Medical Students ◽  
Medical Ethics ◽  
Clinical Ethics ◽  
Core Curriculum ◽  
Tertiary Care ◽  
Medical Schools ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: The importance of doctors being aware of medical ethics has been highlighted in a number of studies. Our first study (Study-1) aims to assess the knowledge, attitude, and practices of medical ethics among clinicians at Patan Academy of Health Sciences (PAHS). We then follow up with the effect of teaching clinical ethics to medical students (Study-2). The purpose of this study is to assess the awareness regarding appropriate ethical principles, application of medical ethics and the effect of teaching medical ethics to students. Methods: There are two studies presented: Study-1 is a cross-sectional questionnaire-based study. A total of 72 participants, selected by simple random sampling, included doctors working as interns, medical officers and consultants in six departments of PAHS. Study-2 was a follow-up, cross-sectional online questionnaire-based comparative study conducted at PAHS to compare KAP of medical ethics among medical officers with and without formal medical ethics training. We used the validated questionnaire from our previous study. All graduates of PAHS 2016 and all medical officers employed at PAHS at the time of study who had graduated from other medical schools that did not include Medical Ethics in their core curriculum were included. Results: Study-1: A positive correlation between Knowledge(p = 0.088), Attitude (p = 0.002), Practice of medical ethics(p = 0.000), and years of practice was found. No significant difference in KAP of medical ethics between MBBS graduates from Nepal and abroad (p = 0.190) was found. The majority scored poorly in issues concerning autonomy. The follow-up study found a statistically significant difference (p = 0.000) in the knowledge between the doctors who were taught medical ethics and those who were not. Conclusions: Doctors find it easier to discuss ethical dilemmas with their colleagues rather than department heads. The KAP of the consultants were found to be better than that of the interns and medical officers. Autonomy is the least understood ethical principle. ‘Medical Ethics’ as a part of the core curriculum in medical schools would improve ethical practice.

scholarly journals Validation of the French version of the Wisconsin Quality of Life (WISQOL) questionnaire for patients with urolithiasis

2020 ◽  
Vol 15 (4) ◽  
Author(s):  
Naeem Bhojani ◽  
Ghizlane Moussaoui ◽  
David-Dan Nguyen ◽  
Mei Juan Trudel ◽  
Garo-Shant Topouzian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Internal Consistency ◽  
Tertiary Care ◽  
Rank Correlation ◽  
French Version ◽  
Spearman’S Rank Correlation ◽  
Significant Difference ◽  
Back Translation ◽  
One Way Anova

Introduction: The Wisconsin Stone Quality of Life (WISQOL) questionnaire has been recently developed to objectively assess QOL in patients with urolithiasis. However, French version of the questionnaire was lacking. Therefore, the aim of the present study was to develop and validate the French version of this tool. Methods: The French version of the WISQOL (F-WISQOL) was developed in a multi-step process involving primary translation, back-translation and pilot testing amongst a group of patients (n=12). Urolithiasis patients from two tertiary care institutions were recruited into this study and completed 3 questionnaires: Perceived Stress Scale-10, medical history form and either the WISQOL or F-WISQOL. Internal consistency was assessed using Cronbach’s α and inter-domain associations were evaluated using Spearman’s rank correlation (r). One-way ANOVA was used to compare scores from the two groups (WISQOL and F-WISQOL). Results: A total of 210 patients were enrolled in this study; 68 in the WISQOL group and 148 in the F-WISQOL group. Internal consistency was high for all domains in both groups (F-WISQOL: 0.924-0.970; WISQOL: 0.888-0.965). No statistically significant difference was found between the two groups’ scores. Inter-domain association, measured by Spearman correlation, was moderate to very strong between all of the domains in the F-WISQOL. Values ranged from r=0.676-0.915, with acceptable correlation between D1, D2 and D3, but weaker correlation between D4 (vitality) and the 3 other domains r=0.676-0.729. Conclusions: In the present study, the French version of the WISQOL questionnaire (F-WISQOL) was validated at two academic institutions.

Cytoreductive Therapeutic Approach in the Essential Thrombocythemia (ET) Patients of the Registro Italiano Trombocitemia (RIT): Preliminary Data

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5248-5248
Author(s):  
Luigi Gugliotta ◽  
Alessia Tieghi ◽  
Anna Candoni ◽  
Monia Lunghi ◽  
Gianluca Gaidano ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Essential Thrombocythemia ◽  
Therapeutic Approach ◽  
Jak2 V617f ◽  
Bone Marrow Biopsies ◽  
Thrombotic Risk ◽  
Significant Difference ◽  
Cytoreductive Treatment ◽  
Wbc Count

Abstract Background: the Registro Italiano Trombocitemia, that is a GIMEMA project, has been activated to registry Italian Essential Thrombocythemia (ET) patients, to improve the diagnosis appropriateness (WHO criteria), to verify the prognostic value of the clinical and biological parameters, to evaluate the compliance to the therapeutical Italian guidelines (1), and to create a network for activation of new studies. Objective: this analysis is mainly devoted to describe the ET patients registered in the RIT and to evaluate the therapeutic approach adopted in the 102 participating hematological centers. Material and methods: two thousand and fifteen ET patients have been registered after the written informed consent was obtained, and data validation by various expert panels is in progress. This preliminary report considers 1785 patients, diagnosed mainly (1078, 60.4%) since the publication in the year 2004 of the ET therapy Italian guidelines (1). Results: the patients, 678 (38%) males and 1107 (62%) females, showed at diagnosis: age 60.3 ± 16.8 years with higher values in males than in females (61.7 ± 15.3 vs. 59.4 ± 17.7, p&lt;0.05), being the patients below 40 years 14% and those over 70 years 33% of cases; PLT count (109/L) 846 ± 309 with lower values in males than in females (813 ± 261 vs. 866 ± 334, p&lt;0.002), and with values 1001–1500 and over 1500 in 16% and 4% of cases, respectively; WBC count (109/L) 9.1 ± 2.9, without difference by sex, and with values 12–15 in 10% and over 15 in 3% of cases; Hgb (g/dL) 14.2 ± 1.6 with higher values in males than in females (14.8 ± 1.5 vs. 13.8 ± 1.5, p&lt;0.001), and with values over 16.5 in 8.5% of males and 2.7% of females, respectively; splenomegaly in 488 (27%), echo-documented in 324 cases (18%); history of hemorrhage and thrombosis in 90 (5%) and 325 (19%) of cases, respectively; disease-related symptoms in 41% and general thrombotic risk factors in 93% of cases, respectively. The WHO 2001 diagnostic criteria were reported for 33% of cases observed before the year 2004 and for 53 % of cases observed since the year 2004. Detailed data at diagnosis were reported as follows: bone marrow biopsy in 1087 cases (61%) with a frequency of 51% and 68% before and since the year 2004, respectively; bcr-abl study in 1045 cases (59%); cytogenetics in 828 cases (46%) with karyotype abnormalities in 27 patients (3%). The JAK2 V617F mutation, searched in 574 cases (32%), was observed in 320 of them (56%). The patient follow-up was 4.5 ± 4.5 years with a total of 5245 pt-yrs. During the follow-up the hemorrhagic events were 5.7% (1.3/100 pt-yrs), being the major events 1.9% (0.4/100 pt-yrs); the thrombotic complications were 14.9 % (3.3/100 pt-yrs), resulting the major arterial 9.4% (2.1/100 pt-yrs), the major venous 3.5% (0.8/100 pt-yrs) and the minor thrombosis 2% (0.4/100 pt-yrs). An antiplatelet treatment, almost always with low dose aspirin, was performed in 75% of the patients, without significant difference in the cases diagnosed before and since the 2004. A cytoreductive treatment was done with use of Hydroxyurea (HU, 64%), Interferon alpha (IFN, 16%), Anagrelide (ANA, 15%), Busulfan (BUS, 4%), and Pipobroman (PIPO, 2 %). In the ET patients diagnosed since the year 2004 respect those diagnosed before, it was observed a decrease in the use of all the cytoreductive drugs, particularly BUS (−62%), IFN ((−62%), and ANA ((−68%). The use of the cytoreductive drugs was related to the patient mean age (years): BUS (76), PIPO (72), HU (67), ANA (53), IFN (48). In the patients diagnosed since the 2004 as compared with those before 2004, the mean age of the treated patients increased for BUS (from 69 to 81 yrs, p&lt;0.001) and for HU (from 64 to 69 yrs, p&lt;0.001) while it decreased for IFN (from 49 to 46 yrs, p&lt;0.05). Conclusion: in the analyzed patients of the ET Italian registry the diagnosis appropriateness resulted improved in the cases observed since the year 2004 respect those observed before, with an increase of bone marrow biopsies from 51% to 68% of patients. Moreover, in accord with the ET therapy Italian guidelines, the use of the cytoreductive drugs was less frequent in the patients diagnosed since the year 2004 than before (particularly for BUS, IFN, and ANA) and the more safe molecules IFN and ANA were preferentially deserved to the younger patients.

Ethylene Diamine Tetra Acetic Acid (EDTA) Decalcification of Paediatric Bone Marrow Trephines In a Diagnostic Laboratory

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2566-2566
Author(s):  
Shriram Vaidia Nath ◽  
Michelle Tamblyn ◽  
Susan Telfer ◽  
Tony Henwood ◽  
Peter Gilham ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acetic Acid ◽  
Turnaround Time ◽  
Ethylene Diamine ◽  
Fish Analysis ◽  
Fluorescence In Situ Hybridisation ◽  
Diagnostic Laboratory ◽  
Bone Marrow Trephine ◽  
The Mean

Abstract Abstract 2566 Background: In paediatric patients with haematological disorders such as acute lymphoblastic leukaemia (ALL), bone marrow aspiration is sometimes difficult to obtain and bone marrow trephine biopsy (BMTB) is a valuable source of material. In a diagnostic laboratory, the turnaround time is critical for a bone marrow trephine to be decalcified, processed and embedded. In our laboratory, 48 hours was routinely required from the time the bone marrow was performed until the sections were ready for reporting. A hydrochloric acid-EDTA (Ethylene-Diamine-Tetra-Acetic acid) decalcifying solution was used for 4 hours but rendered the trephines unsuitable for special studies such as Fluorescence in Situ Hybridisation (FISH). Aim: To evaluate an alternative decalcification method which preserved the ability to perform FISH on formalin-fixed paraffin-embedded (FFPE) tissue without compromising the turnaround time as a laboratory quality improvement measure. Method (EDTA decalcification): Following overnight formalin fixation, the BMTB was decalcified in a solution containing 20% EDTA with continuous stirring for 7.5 hours. The 20% EDTA, pH 7.1 stock solution was prepared by adding Ammonium Hydroxide (25%, concentrated ammonia) (Merck) to distilled water. EDTA disodium salt (372.24; Ajax Finechem) was added and the pH adjusted to pH 7.1 using concentrated ammonia. BM trephines were then processed routinely, embedded in paraffin and 4μm sections were mounted on Super Frost Plus slides. Haematoxylin-Eosin (H&E) staining, Silver Nitrate staining for Reticulin was performed on all slides and Immunocytochemistry, Immunofluorescence and FISH on selected slides. Patient Characteristics: 20 trephines from 15 patients underwent 7.5 hour EDTA decalcification. The diagnosis in 9 patients was Precursor-B ALL while one each had T-Cell ALL, Acute Myeloid Leukaemia, Hodgkin's disease, Refractory Anaemia, Drug Induced Anaemia and Idiopathic Thrombocytopenic Purpura. The mean age was 9.3 years (range 1.9–16.7years) and the mean trephine length was 12.8mm (range 6–21mm). Results: 100% decalcification was achieved in 18 trephines while in 2 trephines 95% decalcification was achieved on morphological examination. The turnaround time was 48 hours. The quality of H&E, reticulin stain, immunohistochemistry and immunofluorescence was maintained and FISH was successful on these FFPE BMTB tissues. This has lead to incorporation of this method for routine use in our laboratory. Conclusion: 20% EDTA decalcification of paediatric BMTB specimens is feasible without affecting the quality of histological preparations or turnaround time. The main advantage of the EDTA decalcification process is that the tissue is amenable to FISH analysis should it be required. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic Impact of Bone Marrow Erythropoiesis on Newly Diagnosed Plasma Cell Myeloma: A Single Institutional Analyses

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5579-5579
Author(s):  
Daniel E Ezekwudo ◽  
Rohit Singh ◽  
Bolanle Gbadamosi ◽  
Mark Micale ◽  
Ishmael Jaiyesimi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Outcome ◽  
Plasma Cell ◽  
Prognostic Impact ◽  
Plasma Cell Myeloma ◽  
Newly Diagnosed ◽  
Bone Marrow Biopsies ◽  
Kaplan Meier ◽  
Significant Difference ◽  
The Impact

Abstract Introduction: In plasma cell myeloma (PCM), tumor burden and activity plays an important role in diagnosis and prognosis (e.g. circulating plasma cells), however very little attention has been directed to the impact of the non-plasma cell component of the bone marrow. The presence of anemia has been used to distinguish PCM from smoldering myeloma; however this can be a non-specific finding as there are many potential causes of anemia besides PCM. We sought to determine if the level of erythropoiesis in bone marrow biopsies may be a more reliable prognostic factor. In the study herein, we assessed the level of bone marrow erythropoiesis in patients with newly diagnosed PCM, and compared those findings with cytogenetic results (CGs), other prognostic factors and overall clinical outcome. We hypothesized that patients with adequate erythropoiesis (AEp) are likely to have favorable cytogenetics and better outcome compared to those with decreased erythropoiesis (DEp). Methods: We retrospectively reviewed pathology database for bone marrow biopsies in patients with diagnosis of plasma cell myeloma (PCM) at Beaumont Hospital, an academic community center from 2012 and 2014. Biopsy cases without anemia were excluded. A total of 91 patients with plasma cell myeloma and anemia were identified. Each biopsy was re-examined to determine the level of erythropoiesis. The level of erythropoiesis was calculated by multiplying erythroid fraction (obtained from M:E ratio) with non-plasma cell bone marrow cellularity. Cases were separated into AEp and DEp using an erythroid compartment cut-off of 7.5% based on already established data. Kaplan-Meier analysis was used to compare survival between groups. Results: Demographic distribution of studied patients were 46 (50.1%) white, 39 (43%) African Americans and 6 (6.6%) others. Out of 91 cases analyzed, 38 (42%) had AEp whereas 53 (58%) had DEp. Among those with AEp, 23 (62%) had favorable CGs (defined as those without t (4, 14), t (14, 16), t (14, 20) or 17 p deletion); 15 (38%) had unfavorable CGs. Among those with DEp, 14 (26%) had favorable CGs whereas 39 (74%) had unfavorable cytogenetics. The vast majority of patients with favorable CGs were alive whether they had AEp (87%) or DEp (79%), thus CGs remained significant even after controlling for erythroid compartment (p = 0.03). Overall, those with AEp were noted to have significantly lower β-2 microglobulin (AEp median =2.42 mg/dL, DEp median = 4.50 mg/dL, p = 0.02). Kaplan-Meier analysis showed a significant difference in survival curves among the four groups (AEp with favorable CGs, AEp with unfavorable CGs, DEp with favorable CGs, DEp with unfavorable CGs, p<.0001). While the two groups with favorable CGs showed no significant difference (p=.6050), the two groups with unfavorable CGs did (p=.0027). Conclusion: Our findings suggest that patients with PCM and anemia are not a homogenous population. Assessment of the erythroid compartment in these patients reveals a population with AEp that has more favorable CGs and lower β-2 microglobulin than patients with DEp. Despite this finding, patients with favorable CGs had a favorable clinical outcome whether they had AEp or not, indicating that current therapies can overcome differences in erythropoiesis in that group. For patients with unfavorable CGs, however, those with AEp had superior survival outcome compared to those with DEp, indicating that there may be some prognostic or diagnostic utility to assessing erythropoiesis in patients who meet current criteria for PCM, and possibly, incorporating erythropoietic activity into diagnostic/prognostic schema. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Prospective Comparison of Bone Marrow Biopsy Adequacy with and without Use of Powered Assistive Drill in the Clinical Setting Versus Interventional Radiology

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4823-4823
Author(s):  
Tara T. Barnett ◽  
Jana M. Reynolds ◽  
Andrew Shakespeare ◽  
Paul Dye ◽  
Edward S. Rappaport ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Interventional Radiology ◽  
Bone Marrow Biopsy ◽  
Clinical Setting ◽  
Tertiary Care ◽  
Bone Marrow Biopsies ◽  
Ct Guided ◽  
Clinical Site ◽  
The Mean ◽  
The Impact

Abstract Background The adequacy of bone marrow biopsies is most often defined by trephine length. By this definition, adequacy has been associated with the experience of the procedure operator. In small prospective studies, powered assistive drills have also affected adequacy as their use has been shown to yield longer trephine lengths as compared to manual devices. Within our Central Texas academic institution tertiary care center, we have noted the two following recent changes in our bone marrow biopsy practice: routine implementation of the powered assistive drill and the use of interventional radiology for CT-guided bone marrow biopsies of more difficult patients (i.e. obese body habitus, altered anatomy, previous failed attempts, etc.), and those who desire sedation. This study aims to review the impact of powered assistive drill use and referral to interventional radiology on the adequacy of bone marrow biopsies at our institution. Methods Consecutive bone marrow biopsies performed at the Baylor Scott & White Health clinical site 1 (CS1), one of the satellite clinics (CS2), and interventional radiology (IR) from January 1, 2011, through December 31, 2013, were eligible for inclusion. Patients less than 18 years of age were excluded. A prospective registry recorded the date of procedure, patient medical record number, patient age, as well as the presence of spicules within the aspirate (yes or no), and trephine length (in mm) determined by pathology. Procedure location and use of the powered assistive drill for each procedure were determined by billing codes. Trephine length was compared between locations and by use of the assistive drill with Wilcoxon two-sample tests. Results In total, 888 bone marrow biopsies were performed. 753 were performed in the clinical setting (554 at CS1 and 199 at CS2), and 135 in IR. Overall, 326 biopsies utilized the powered drill and 562 were performed manually. Mean trephine length, independent of assistive drill use, was 10.1 mm, 10.3 mm, and 7.4 mm at CS1, CS2, and IR locations respectively; with a significantly shorter trephine length observed in IR as compared to CS1 (p < 0.0001), and CS2 (p <0.0001). The mean trephine length of biopsies obtained with use of the assistive drill was significantly longer than those performed manually at CS1 (10.8 mm vs 9.3 mm [p = 0.0004]), and in IR (10.6mm vs 5.9 mm [p <0.0001]), respectively. There was no difference in mean trephine length between CS1 and IR with use of the drill (10.8 mm and 10.6 mm [p = 0.8123]). The presence of spicules did not differ with the use of the assistive drill at either location (p = 0.9463). CS2 has not yet implemented the routine use of the powered assistive drill. Discussion A statistically significant increase in mean trephine length was observed with use of the assistive drill between CS1 and IR, though the only difference of clinical significance was that observed in IR. With use of the drill, however, the mean trephine lengths between our clinical site and interventional radiology was no longer statistically significant. The use of the assistive drill in IR simply increased trephine length to equal those obtained routinely in the clinical setting. This suggests the use of powered assistive devices, in a patient population for whom CT-guidance is necessary, may increase the likelihood of obtaining a trephine of similar adequacy to those performed on the “ideal” patient at the bedside by experienced operators. Disclosures No relevant conflicts of interest to declare.

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