Clinicopathological Evaluation of Metastatic Carcinomas of Bone Marrow Presenting as Cytopenia

Background – Metastatic carcinomas can involve bone marrow and may lead to subsequent marrow fibrosis and failure. The Bone marrow examination is important in patients diagnosed or patients on chemotherapy for cancer, who presented with peripheral cytopenia. The metastasis of bone marrow by these tumors is a sign of advanced stage of disease with poor prognosis. Methods – Our study is a retrospective study, in which we reviewed a total of 702 bone marrow procedures, out of which 118 bone marrow procedures done in patients with a diagnosis of cancer or patients on chemotherapy presented as cytopenia in Great Eastern Medical College and Hospital during a period of 10 years. Result – In our study of 118 patients 74 males and 44 females. Peripheral smear examination of these cases - 24 out of 32 (75%) presented with anemia, which was the commonest clinical presentation. Others were, thrombocytopenia in 18 (50%), bleeding manifestations in 10 (31.2%), Pancytopenia in 9 (28.1%), bi-cytopenia in 4 (12.5%). During this study period, among 118 malignancies reported in histopathology, 32 cases show bone marrow metastasis. 17.1% were carcinoma breast, 25% were carcinoma stomach 33.3% were carcinoma prostate and carcinoma urinary bladder, 23.5% were SCC carcinoma lung, 0% carcinoma Cervix, all cases of Ewing’s sarcoma, neuroblastoma and poorly differentiated carcinoma show bone marrow metastasis. Conclusion - Bone marrow examination is valuable tool in the diagnosis and staging of hematologic and nonhematological disease, as well as in the assessment of overall bone marrow cellularity, pattern of marrow involvement in metastatic carcinomas.

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Clinico-haematological profile of adult pancytopenia patients at a tertiary care institute in South India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210435 ◽

2021 ◽

Vol 9 (2) ◽

pp. 521

Author(s):

Nadia Shafi Chikan ◽

Qazi Mohammad Iqbal ◽

Altaf Hussain Mir

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Examination ◽

Hematological Disorders ◽

Medical College ◽

Haematological Profile ◽

Bone Marrow Study ◽

Hypercellular Marrow ◽

Rule Out

Background: Pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leukopenia and thrombocytopenia resulting from a number of disease processes. Varieties of hematological and non-hematological disorders may affect bone marrow either primarily or secondarily, resulting in the manifestation of pancytopenia. The incidence of various hematological disorders causing pancytopenia varies due to geographical distribution and genetic predisposition. This study highlights the spectrum of causes, clinical presentation and bone marrow morphology of pancytopenia.Methods: This prospective observational study was conducted for a period of two years at Al-Ameen Medical College, Bijapur, Bangalore. During this period, fifty patients with a hematological diagnosis of pancytopenia were studied during period in the department of pathology.Results: Among the 50 cases studied, 35 were males and 15 were females. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was predominant blood picture. Bone marrow study showed 72% hypercellular marrow, 12% normocellular and 16% hypocellular marrow. The commonest cause for pancytopenia was megaloblastic anemia followed by iron deficiency anaemia and malaria.Conclusions: The present study concludes that detailed hematological investigations along with bone marrow examination in pancytopenic patients is helpful to diagnose or rule out the causes of pancytopenia.

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A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201080 ◽

2020 ◽

Vol 7 (4) ◽

pp. 566

Author(s):

Janak G. Chokshi ◽

Bhargavkumar I. Patel ◽

Ishvarlal M. Parmar ◽

Dipen R. Damor

Keyword(s):

Bone Marrow ◽

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Bone Marrow Examination ◽

Radiological Imaging ◽

Peripheral Smear ◽

Drug Induced ◽

Presenting Symptoms ◽

Function Test ◽

B12 Deficiency

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

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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

Recent Advances in Biology and Medicine ◽

10.18639/rabm.2016.02.290354 ◽

2016 ◽

Vol 02 ◽

pp. 29

Author(s):

Rashmi Kaul Raina ◽

Sujeet Raina ◽

◽

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Geographical Location ◽

Bone Marrow Examination ◽

Laboratory Evaluation ◽

Western Himalayas ◽

Diagnostic Challenge ◽

Medical College ◽

Hypercellular Marrow ◽

New Onset

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.

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Interpretation of bone marrow aspiration in hematological disorder

Journal of Pathology of Nepal ◽

10.3126/jpn.v2i4.6885 ◽

2012 ◽

Vol 2 (4) ◽

pp. 309-312 ◽

Cited By ~ 8

Author(s):

S Pudasaini ◽

KBR Prasad ◽

SK Rauniyar ◽

R Shrestha ◽

K Gautam ◽

...

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Microcytic Anemia ◽

Lymphoid Leukemia ◽

Hematological Disorders ◽

Medical College ◽

Erythroid Hyperplasia ◽

Hematological Disorder

Background: Hematological disorders are quite frequent in all age group. Most of this hematological disorder first present as anemia. Bone Marrow Aspiration plays a major role in the diagnosis of its underlying cause. The aim of this study was to analyze the causes of hematological disorders, its spectrum and to interprete the bone marrow aspiration findings.Materials and Methods: This was a retrospective and prospective study carried out in the department of Pathology of Nepal Medical College in a period of two years. (July 2010 - June 2012). Bone marrow examination of 57 cases of suspected hematological disorders was carried out. All details of the patients were obtained from the record file in the department of pathology.Results: Out of 57 cases of bone marrow aspiration, erythroid hyperplasia was seen in 12 cases (21%). Megaloblastic anemia was seen in 7 cases (12.3%) and microcytic anemia was seen in 4 cases (7%). There were 6 cases (10.5%) of Idiopathic Thrombocypenic Purpura. Acute leukemia was diagnosed in 7 cases (12.3%) and among this acute myeloid leukemia (10.5%) was more common than acute lymphoid leukemia (1.8%). Myelodysplastic syndrome and multiple myeloma was seen in 3.5 % cases each. Aplastic anemia and kalaazar was seen in 5.3% and 1.8% cases respectively.Conclusion: Bone marrow examination is an important step to arrive at the confirmatory diagnosis of many hematological disorders.Journal of Pathology of Nepal (2012) Vol. 2, 309-312DOI: http://dx.doi.org/10.3126/jpn.v2i4.6885

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Bicytopenia/pancytopenia in children - clinico etiological profile and importance of bone marrow evaluation in a tertiary care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20205514 ◽

2020 ◽

Vol 8 (1) ◽

pp. 102

Author(s):

Lalita Wadhwa ◽

Suman Chirla ◽

Maheshwari K. ◽

Puneet Wadhwa

Keyword(s):

Bone Marrow ◽

Tertiary Care ◽

Bone Marrow Examination ◽

Study Data ◽

Clinical Feature ◽

Tertiary Care Centre ◽

Peripheral Smear ◽

Bone Marrow Evaluation ◽

Hematological Analysis ◽

Common Etiology

Background: Peripheral cytopenia is a common hematological problem in our day-to-day clinical practice resulting from various diseases ranging from transient infection induced bone marrow suppression to life threatening hematological malignancies. The objective of this study was to know the clinicoetiological profile,hematological analysis and importance of bone marrow evaluation of bicytopenia/pancytopenia in children in a tertiary care teaching hospital.Methods: This was a retrospective, observational study, conducted in pediatric department, NRIIMS, Visakhapatnam, Andhra Pradesh from May 2019 to May 2020. All children in the age group of 1-18yrs of age admitted with new onset bicytopenia/pancytopenia who underwent hematological analysis and bone marrow examination in our hospital were included in this study. Children with bicytopenia/ pancytopenia evaluated outside/treated in other hospitals were excluded from our study. Data was obtained from bone marrow biopsy register from pathology department, admission register of pediatric ward and hospital medical records.Results: Out of the 31 children studied, males were (54.8%), females were (45.2%).11-18 years of age were (51.6%), 1-5 years of age were (38.7%). Fever (77.4%), pallor (74.1%), hepatosplenomegaly (41%) was the most common clinical feature noted in these patients. ALL (52.3%), followed by ITP (9.52%) was the most common etiology for bicytopenia. Aplastic anaemia (40%), megaloblastic anaemia (20%) were most common etiology noted for pancytopenia. Bicytopenia (67.7%) was more common than pancytopenia (32.2%).Peripheral smear examination picked up only 11 out of 14 cases of haematological malignancy, identified by bone marrow examination. Most common bone marrow finding noted was ALL (38.7%), followed by hypocellular bone marrow (22.5%).Conclusions: When there is high index of clinical suspicion and peripheral smear is unable to pick up these cases, it is advisable to do bone marrow examination at the earliest for early confirmation.

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Utility of Platelet Count and Platelet Indices in the Evaluation of Thrombocytopenia

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/608 ◽

2020 ◽

Vol 7 (49) ◽

pp. 2974-2980

Author(s):

Tejaswi Peddaverannagari ◽

Nalinimohan Chakkirala ◽

Shailaja Prabhala ◽

Ashokkumar Deshpande

Keyword(s):

Bone Marrow ◽

Platelet Count ◽

Bone Marrow Examination ◽

Mean Value ◽

Distribution Width ◽

Platelet Indices ◽

Medical College ◽

Immune Mediated ◽

Low Platelet Count ◽

The Difference

BACKGROUND Thrombocytopenia is defined as a low platelet count, less than 150000 / microlitre which is attributed to a variety of haematological and pathological disorders. It can result from four different mechanisms like hypoproduction, hyperdestruction, abnormal platelet distribution and dilutional loss. The type of mechanism leading to thrombocytopenia can be determined with the help of platelet count and platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (Pct). We wanted to study the utility of platelet count and platelet indices in the evaluation of thrombocytopenia, evaluate platelet indices as a diagnostic tool in differentiating various types of thrombocytopenia and correlate platelet indices with bone marrow findings. METHODS This was a prospective observational study done in a teaching medical college in India over a period of two years from June 2017 to May 2019. The patients were divided into two groups as hyperdestructive and hypoproductive related thrombocytopenia. The platelet count and platelet indices were determined in a five part haematology autoanalyzer and were compared with suitable controls. Findings were correlated with Bone marrow examination for exact aetiology RESULTS A total of 60 patients was considered for the study, of which 21 belonged to hyperdestructive thrombocytopenia and 39 belonged to hypoproductive group. All 21 cases in the former group were of immune mediated thrombocytopenia (ITP). MPV 11.51 ± 1.97 was significantly higher in hyperdestructive thrombocytopenia as compared to hypoproductive thrombocytopenia wherein it was 8.34 ± 2. PDW was also more in the former group as compared to latter and showed a mean value of 16.67 ± 1.03 and 14.68 ± 2.29 respectively. The difference in Pct was insignificant in determining the cause of thrombocytopenia between the groups. CONCLUSIONS Platelet indices give valuable preliminary information as to the type of thrombocytopenia, i.e. hyperdestructive or hypoproductive type. This will guide in patient management decisions and may obviate the need for bone marrow examination in at least some patients. Also platelet indices do not need extra blood sample and do not incur additional cost. KEYWORDS Hyperdestructive, Hypoproductive Thrombocytopenia, Platelet Indices, Bone Marrow, ITP

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Haematological Evaluation in Patients of Pancytopenia by Bone Marrow Aspiration

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/295 ◽

2021 ◽

Vol 10 (19) ◽

pp. 1398-1402

Author(s):

Pallavi Agrawal ◽

Yogesh Singh ◽

Nutan Agrawal

Keyword(s):

Bone Marrow ◽

Developing Countries ◽

Blood Count ◽

Complete Blood Count ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Definitive Diagnosis ◽

Megaloblastic Anaemia ◽

Medical College ◽

Uncommon Condition

BACKGROUND Pancytopenia is a reduction in all three major series of formed elements of blood i.e. erythrocytes, leucocytes and platelets. Pancytopenia is not an uncommon condition encountered in day to day clinical practice. The underlying aetiology of pancytopenia determines the management and prognosis of patients. Bone marrow aspiration is a minimally invasive, out-patient procedure which provides definitive diagnosis in a case of pancytopenia. In developing countries like India, the causes of pancytopenia are not well defined, hence, we conducted this study in Bundelkhand region of India to evaluate causes of pancytopenia. We wanted to evaluate haematological findings in patients of pancytopenia, and to study bone marrow findings by bone marrow aspiration to understand the underlying aetiology of pancytopenia. METHODS This prospective study was conducted in the Department of Pathology at MLB Medical College, Jhansi, among 65 patients over a one and a half year period from March 2018 to September 2019, to evaluate the causes of pancytopenia. RESULTS We found that out of 65 cases, 32 cases were of megaloblastic anaemia (49.23 %), 20 cases were of dimorphic anaemia (30.77 %), 6 cases were of hypersplenism (9.23 %), 4 cases were of subleukemic leukemia (6.15 %), 2 cases of aplastic anaemia (3.7 %) and 1 case was of myelodysplastic syndrome (1.54 %). CONCLUSIONS Along with detailed clinical examination and complete blood count, bone marrow examination is indispensable to diagnose the aetiology of pancytopenia, thereby helping clinician in planning management of these patients. KEY WORDS Pancytopenia, Megaloblastic Anaemia, Dimorphic Anaemia, Bone Marrow Examination

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CLINICAL ASSESSMENT OF PANCYTOPENIA IN PERIPHERAL BLOOD SMEARS IDENTIFIED IN PATIENTS FROM BIHAR REGION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i8.573 ◽

2019 ◽

Vol 3 (8) ◽

Author(s):

Dr. Vivek Kumar ◽

Dr. Jaideo Prasad

Keyword(s):

Bone Marrow ◽

Peripheral Blood ◽

Megaloblastic Anemia ◽

Bone Marrow Aspiration ◽

Peripheral Blood Smear ◽

Bone Marrow Examination ◽

Peripheral Smear ◽

Blood Smears ◽

Function Test ◽

Peripheral Blood Smears

The severity of pancytopenia and the underlying pathology determine the management and prognosis. [3] Thus, identification of exact cause will help in implementing appropriate therapy. The major diagnostic problems occur when there are no specific features in the peripheral smear to point the cause. In India the causes of pancytopenia are not well defined, so the present study has been undertaken to evaluate the various causes and to correlate the peripheral blood smear findings. The present study was planned in Department of Pathology, Anugrah Narayan Magadh Medical College, Gaya, Bihar from july 2017 to Dec 2017. Total 50 cases of the clinical suspicion of a hematological disorder and demonstrating pancytopenia in the peripheral blood smears were enrolled in the present study. All participants underwent a detailed history, clinical examination and investigations which included complete blood picture with red cell indices and peripheral smear, liver function test, renal function test, ultrasound abdomen and bone marrow examination in all cases. Cause of pancytopenia was ascertained and data was analysed on SPSS on the basis of etiology, clinical and haematological findings. The data generated from the present study concludes that systematic and thorough workup is required in patients presenting with pancytopenia, so that elimination of the cause is needed to treat the condition. Among them, megaloblastic anaemia and infections are early treatable and reversible. Keywords: Pancytopenia, Bone Marrow Aspiration, Megaloblastic Anemia, Hypo plastic Marrow, etc

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