Bone marrow aspiration in haematological disorders: study at a tertiary care centre

Background: The bone marrow examination is an essential investigation for the diagnosis and management of many disorders of the blood and bone marrow. Bone marrow aspiration (BMA) alone is usually sufficient to diagnose nutritional anaemias, and most of the acute leukaemias. Aim was to study the spectrum of haematological disorders diagnosed on bone marrow aspiration.Methods: This study was conducted in the Department of Clinical Haematology in Sher e Kashmir Institute of Medical Sciences, Kashmir for a period of 2 years from December 2015 to December 2017. Bone marrow examination of 2131 cases of suspected hematological disorders was carried out. Bone marrow was aspirated from posterior superior iliac spine under local anaesthesia. Aspirates of dry tap were excluded from the study. Aspiration smears where stained with Leishmann stain for morphological examination.Results: A total of 2131 cases were included in this study. Male to female ratio in our study was 1.9:1. The age range of cases was from 1-80 years and the mean age was 47.3 years. Anemia was the most common haematological disorder in our study accounting for 25.6% of cases followed by acute leukaemia accounting for 22.3% and multiple myeloma (13.3%). Among anemias, megaloblastic anemia was most common followed by dual deficieny anemia. Among leukaemias, acute myeloid leukaemia (13.2%) was more common than acute lymphoblastic leukaemia (9.1%).Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many hematological and non-hematologic diseases that can be confirmed by more advanced investigations viz. serological, biochemical or molecular. It is a highly informative test procedure performed for evaluating blood and blood related diseases in our environment.

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DIAGNOSTIC IMPORTANCE OF BONE MARROW ASPIRATION IN HEMATOLOGICAL DISORDERS – TERTIARY CARE CENTRE BASED STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.339 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Seema Meena ◽

Sukriti . ◽

Sonal Bhati ◽

Abha Patni

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Deficiency Anemia ◽

Invasive Technique ◽

Care Centre ◽

Tertiary Care Centre ◽

Female Ratio ◽

Hematological Disorders

Background: Bone marrow aspiration (BMA) is a minimally invasive technique performed in a variety of hematological disorders. It is considered essential for the diagnosis and management of haematological disorders. BMA is usually sufficient to diagnose nutritional anemia and most of the leukemias. Aims & Objectives: To study the spectrum of hematological disorders diagnosed on BMA in a tertiary care centre, Udaipur. Material & Methods: The present study was conducted in the hematology section of department of Pathology, RNT Medical College & MB Hospital, Udaipur for a period of one year from June 2018 to May 2019. A total of 123 cases of suspected hematological disorders underwent the process of BMA from posterior superior iliac spine under local anesthesia. Exclusion criteria of our study included aspirates of dry tap. BMA smears were stained with Giemsa stain for morphologic examination. Result: The present study included 123 cases. Male to female ratio in our study was 1.6:1. Anemia (45.5%) was the most common hematological disorder in our study, iron deficiency anemia being the most common followed by megaloblastic anemia. Chronic myeloid leukemia (26.01%) was the most common hematological malignancy in our study. Conclusion: Bone marrow aspiration is a useful diagnostic procedure in hematological practice for the diagnosis of both hematological and non-hematological conditions. Rapid and early diagnosis of malignancies are critical for proper initiation of treatment and to control the disease. Keywords: Bone Marrow Aspiration, Hematological disorders, Leukemias

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

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.3349 ◽

2021 ◽

Vol 71 (2) ◽

pp. 672-75

Author(s):

Sunila Tashfeen ◽

Naveed Asif ◽

Shafia Nasir ◽

Muhammad Azam ◽

Zareen Irshad

Keyword(s):

Bone Marrow ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Unknown Origin ◽

Bone Marrow Examination ◽

Military Hospital ◽

Care Centre ◽

Tertiary Care Centre ◽

Female Ratio ◽

Haematological Disorders

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.

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A comparative study of bone marrow aspirate with trephine biopsy in pancytopenia disorders

IP Journal of Diagnostic Pathology and Oncology ◽

10.18231/j.jdpo.2021.043 ◽

2021 ◽

Vol 6 (3) ◽

pp. 201-206

Author(s):

Kavya J ◽

Kalpana Kumari MK

Keyword(s):

Bone Marrow ◽

Sensitivity And Specificity ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Care Hospital ◽

Trephine Biopsy ◽

Hematological Disorders ◽

Hematoxylin And Eosin

Pancytopenia is commonly reported in clinical hematology practice. Due to its varied marrow pathology and underlying ailments, diagnosis is often misleading and delayed. Bone marrow examination would provide a comprehensive diagnosis of both blood and bone marrow, since aspirate investigates the cytological morphology and biopsy evaluates the cellularity, architecture, and compact marrows.To compare bone marrow aspiration and trephine biopsy results in the diagnosis of pancytopenia, and to determine the sensitivity and specificity of aspirate examination in pancytopenia diagnosis.This prospective study was conducted at a tertiary care hospital from July 2014 to June 2016. A total of 320 samples were received at the department of pathology for bone marrow examination (aspirate and biopsy). Romanowsky (Leishman) stain was used to investigate aspirate samples. All biopsy samples were processed into 3-5 μ blocks and stained using hematoxylin and eosin after decalcification with 5.5% EDTA. Data analysis was performed using SPSS19.Pancytopenia constituted 56 (18.7%) cases with the mean age of 41.79 years. Of the total pancytopenia cases, hematological disorders constituted 50 (89.3%) cases and 6 (10.7%) were non-hematological cases. Aspirate and biopsy diagnosis positively correlated in 76.79% of cases. A 100% sensitivity and specificity of aspirate diagnosis was observed in, acute myeloid leukemia, hypersplenism, myelodysplastic syndrome, megaloblastic anemia, hematological malignancy in remission and negative for lymphoma infiltrate. Aspirate had no role in diagnosis of uremic osteodystrophy and myelofibrosis, whereas leishmaniasis was diagnosed on aspirate alone.Pancytopenia includes multiple underlying ailments which requires a differential diagnosis approach. Combining both aspirate and biopsy for diagnosis would benefit the patient in prognosis as they are complementary to each other.

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EVALUATION OF PANCYTOPENIA IN ADULTS PATIENTS OF BIHAR

10.36106/ijsr/2006035 ◽

2021 ◽

pp. 6-7

Author(s):

Rachana Rachana ◽

Nivedita Singh ◽

Om Prakash Diwedi

Keyword(s):

Bone Marrow ◽

Complete Blood Count ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Clinical History ◽

Bone Marrow Examination ◽

Underlying Disease ◽

Care Hospital ◽

Detailed Clinical History

INTRODUCTION– Pancytopenia usually indicates presence of serious underlying disease. Determining the etiology of pancytopenia is important for appropriate management of the patients. AIMS AND OBJECTIVES- This study was undertaken to identify the etiological factors leading to pancytopenia in a tertiary care hospital of Bihar. MATERIAL AND METHODS– This was a prospective study conducted over 12 months in the department of pathology, Nalanda medical college, Patna. The study included adult patients (>18yrs) who had pancytopenia in complete blood count. Relevant blood tests and bone marrow aspiration (BMA) and bone marrow biopsy (BMB) were done to delineate the etiology of pancytopenia. RESULTS– The commonest cause of pancytopenia in our study was aplastic anemia (46.67%) followed by megaloblastic anemia (23.33%) and hematological malignancies (acute leukemia and lymphoma- 15%). Other causes include infective diseases (kala-azar, malaria and tuberculosis), hypersplenism and hemophagocytosis. CONCLUSION- Determination of etiology of pancytopenia needs detailed clinical history and physical examination, and appropriate hematological tests and bone marrow examination.

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Complementry Role of Bone Marrow Aspiration and Biopsy

10.47363/jpr/2021(3)130 ◽

2021 ◽

pp. 1-3

Author(s):

Nirali Shah ◽

◽

Vidhi Shah ◽

Falguni Goswami ◽

Roopam Gidwani ◽

...

Keyword(s):

Bone Marrow ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Central Laboratory ◽

Tertiary Care Centre ◽

Hematological Disorders ◽

Complementary Role ◽

Important Diagnostic Tool

Introduction: Bone marrow examination is an important diagnostic tool to evaluate various hematological and non-hematological disorders. The two most important techniques used for the diagnosis are bone marrow aspiration and bone marrow biopsy which play complementary role with each other when performed simultaneously. Aims and Objectives: Study was done to compare the results of BMA and BMB and by that to prove the complementary role of both techniques to each other. Material and Methods: We evaluated total 74 cases in central laboratory, department of pathology, at tertiary care centre. All aspirations were stained by giemsa and iron stain while all biopsy were stained by routine H&E stain. Reticulin stain and IHC markers were used as and when required. Result: Out of total 74 cases, 40 cases showed positive corelation between these two techniques (54%). In two cases aspiration was not possible. In 8 cases biopsy was not done. 4 cases showed crushing artefact in BMB while 3 cases of aspiration were either diluted or dry tap. In all these cases diagnosis became possible by the alternate technique. BMB replaced BMA and vice versa as and when required. Conclusion: BMA and BMB are complementary procedure which yields extra support in diagnosing various hematological and non hematological disorders when one or other technique fails due to some reason

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Evaluation of bone marrow in cases of pancytopenia in a tertiary care hospital

Journal of Pathology of Nepal ◽

10.3126/jpn.v5i9.13686 ◽

2015 ◽

Vol 5 (9) ◽

pp. 691-695

Author(s):

S Vaidya

Keyword(s):

Bone Marrow ◽

Aplastic Anemia ◽

Tertiary Care Hospital ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Care Hospital ◽

Diagnostic Modality ◽

Number Of Patients

Background: A spectrum of primary and secondary disorders that affect the bone marrow may manifestwith pancytopenia. This study was carried out to identify the various causes of pancytopenia in patients attending a tertiary care hospital in Lalitpur, Nepal.Materials and Methods: A descriptive study of 83 cases of pancytopenia was carried out in the Department of Pathology, Patan Academy of Health Sciences, Lalitpur, Nepal over a two year period from August 2010 to July 2012.Results: Eighty three patients underwent bone marrow examination. Mean age of the patients was 34 years (range: 4 to 75 years). Maximum number of patients (31.33%) was seen in the age group of 16 - 30 years. The commonest cause of pancytopenia was megaloblastic anemia which was seen in 34.94% (29/83) cases followed by aplastic anemia and hematological malignancies in 31.32% (26/83) and 14.46% (12/83) cases, respectively.Conclusion: This study concluded that megaloblastic anemia and aplastic anemia were the two most common causes of pancytopenia. Bone marrow aspiration is an established diagnostic modality in the evaluation of pancytopenia.Journal of Pathology of Nepal (2015) Vol. 5, 691 - 695

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Clinico-Haematological Study of Pancytopenia – An Experience from a Tertiary Care Centre in Western Odisha

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/385 ◽

2021 ◽

Vol 8 (24) ◽

pp. 2052-2057

Author(s):

Anupa Toppo ◽

Harish Chandra Singh ◽

Rojalin Nanda

Keyword(s):

Bone Marrow ◽

Aplastic Anaemia ◽

Tertiary Care ◽

Disease Process ◽

Bone Marrow Aspiration ◽

Megaloblastic Anaemia ◽

Care Hospital ◽

Haematological Malignancies ◽

Female Ratio ◽

Haematological Disorders

BACKGROUND Pancytopenia is a relatively common haematological entity with simultaneous presence of anaemia, leucopenia and thrombocytopenia. It is a feature of many medical and haematological disorders like megaloblastic anaemia, drug-induced bone marrow hypoplasia, even fatal leukaemia and bone marrow aplasia. The clinical and haematological studies determine the proper diagnosis and management of patients. Bone marrow examination is an important diagnostic procedure for determining the cause of pancytopenia. This study was conducted to evaluate clinico-haematological findings, identify the causes of pancytopenia, and compare our findings with other similar studies. METHODS The four-year retrospective study was carried out in the Department of Pathology at a tertiary care hospital in western Odisha, India. Data regarding clinical details, peripheral blood and bone marrow aspirations were collected and analyzed using simple statistical methods. RESULTS A total of 131 cases of pancytopenia were studied. The age range of patients was 3 years to 72 years, with a mean of 36.5 years. Male to female ratio was 0.84 : 1. The majority of cases were in the age group of 31 – 40 years (20.61 %). Generalized weakness with pallor (54.96 percent) was the commonest clinical finding, followed by splenomegaly (16.79 %), and hepatomegaly (11.45 %). Aplastic anaemia (43.51 %) was the most common cause found on the bone marrow aspiration followed by megaloblastic anaemia (22.14 %) and haematological malignancies. Among the haematological malignancies, acute myeloid leukaemia was the commonest cause of pancytopenia (10.69 %). CONCLUSIONS Bone marrow aspiration in cytopenic patients helps in understanding the disease process and to diagnose or rule out the causes of cytopenia. Different geographical areas have a different presentation of haematological disorders. KEYWORDS Bone Marrow Aspiration, Pancytopenia, Aplastic Anaemia

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Bone marrow aspiration and anemia; Diagnostic importance of bone marrow aspiration and biopsy in evaluating patients presenting with anemia of unknown etiology.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.02.4476 ◽

2020 ◽

Vol 27 (02) ◽

pp. 419-423

Author(s):

Muhammad Ihtesham Khan ◽

Asif Hussain Munir ◽

Syeda Hina Fatima

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Blood Film ◽

Deficiency Anemia ◽

Unknown Etiology ◽

Cross Sectional ◽

Female Ratio ◽

Diagnostic Importance

Objectives: To determine the diagnostic importance of bone marrow aspiration and biopsy in work up of cases presenting with anemias of unknown etiology. Study Design: Cross sectional descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Period: July 2015 to July 2017 (two year). Material & Methods: All patients presenting with anemia (Hemoglobin less than 12gm/dL for females and 13 gm/d L for males), whose cause cannot be established on clinical history, examination and blood counts, and were thus referred for bone marrow examination for further workup were included in the study. Patients having malignancies, chemotherapy or radiotherapy associated marrow suppression, and those with diluted marrow unfit for comments were excluded from the study. Bone marrow aspiration and biopsy was done, slides were examined, and diagnoses was made and recorded. The results were drawn accordingly. Results: A total of 199 patients were referred for bone marrow aspiration, presenting with unexplained anemia, during the study period. About 12 patients had blast cells on peripheral blood film, giving diagnosis of leukemia. So they were excluded from the study. Remaining 187 cases were included in the study. The age of the study sample ranged 3 years to 63 years (mean age 42 years ±8.1 SD). There were 96 (51%) males and 91 (49%) females. Male to female ratio was 1.05:1. Out of 187 cases presenting with unexplained anemias, about 44(23.5%) cases were of iron deficiency anemia, 39(20.7%) cases were of anemia of chronic disorder, 16 (8.7%) cases as hemolytic anemia, about 19 (10.3%) cases as aplastic anemia, and 52 (27.8%) cases of megaloblastic anemia on bone marrow examination. Conclusion: Bone marrow aspiration and biopsy successfully gives the final diagnosis in cases of anemia where cause cannot be found by routine lab investigations. It helps physician decide further management plan of the patients. So, it should be done in all cases with unexplained anemia.

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TO DETERMINE THE FREQUENCY OF VISCERAL LEISHMANIASIS IN PERIPHERAL CYTOPENIC PATIENT IN PATHOLOGY DEPARTMENT HAYATABAD MEDICAL COMPLEX.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2014.4.2.560-566 ◽

1969 ◽

Vol 4 (2) ◽

pp. 560-566

Author(s):

ZARD ALI KHAN ◽

MOHAMMAD SAJJAD ◽

IMRAN UD DIN ◽

MUKAMIL SHAH ◽

SHAH JEHAN

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Case Series ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Total Leukocyte Count ◽

Full Blood Count ◽

Female Ratio ◽

Pathology Department ◽

Case Series Study

BACKGROUND: Visceral Leishmaniasis is a chronic disease and was first described in 1903, byLIESHMAN and DONOVAN. The disease is common in tropical and sub tropical areas of the worldwith various hematological manifestations. It is characterized by fever, visceromegaly, weight loss,pancytopenia and hypergammaglobulenemia. The disease is silent killer, invariably killing almost alluntreated patients, but curable with hematological improvement within 4-6 weeks of treatment.OBJECTIVE: To determine the frequency of Visceral Leishmaniasis in patints with cytopenias .MATERIAL AND METHODS: A descriptive study conducted in Pathology department, HayatabadMedical Complex, Hayatabad from September 1, 2012 to August 31, 2013. This study comprises of 126patients, subjected to complete blood counts. Diagnosis were confirmed by finding Amastigote( L/Dbody) from bonemarrow aspirate. All the patients who were referred to pathology Department of thehospital for bone marrow examination, with the results of peripheral blood using automatedHaematology analyzer, Sysmex KX 21 showing cytopenia were included in the study. Consent wastaken from the patient for bone-marrow aspiration procedure. After consent detailed history, physicalexamination was done.Laboratory investigations i.e. full blood count, which includes hemoglobin estimation, white blood cell,red blood, and platelet count.Bone marrow cytology (Giemsa stain) was recorded on the designed profroma.Posterior superior iliac spine (PSIS) was used as the site for aspiration in adults and children over 2years of ageRESULT: Descriptive case series study of 126 patients of peripheral cytopenia. In which 77 (61.1%)patients were males and 49 (38.9%) were female with male to female ratio of 1.57: 1 It was also foundin this study that visceral leishmaniasis was present in 29 (23%) of cases and the male: female were 1.6:1. Result of the automated hematology analyzer of peripheral cytopenic patients in visceralleishmaniasis show that all of the patients were having total leukocyte count less than 4000/cmm(100%). The hemoglobin level wass less than lOgm/dl in 26 cases (87.7%) and more than lOgm/dl inthree cases (10.3%). In case of platelets count, 27 cases (93.1%) were having platelets count less than150000/cmm.CONCLUSION: Incidence of visceral leishmaniasis is highier in children age group 1-10 years, alsomales are more prone than females. Leukopenia is recorded in all (100%) of the cases, followed bythrombocytopenia (93.1%) and anemia (Hb <10gm %) 87.7% cases.KEY WORD: Visceral Leishmaniasis, Kala Azar, Amastigote (L/D body)

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