scholarly journals Etiological and Clinical Spectrum of Pancytopenia Based on Bone Marrow Examination

2019 ◽  
Vol 20 (2) ◽  
pp. 68-71
Author(s):  
Prodip Kumar Biswas ◽  
Md Hafiz Sardar ◽  
Gopal Chandra Saha ◽  
Mohammed Shahadat Hossain ◽  
AKM Humayon Kabir ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Practice ◽  
Aplastic Anemia ◽  
Megaloblastic Anemia ◽  
Bone Marrow Examination ◽  
Clinical Spectrum ◽  
Total Leukocyte Count ◽  
Focal Lesion ◽  
College Hospital ◽  
Female Ratio

Background: Bone marrow aspiration is assessed for cytology and trephine biopsy provides overall cellularity, detection of focal lesion and infiltration. Bone marrow study plays a crucial role in identifying cause of aplastic anaemia in clinical practice. This study was carried out to see the etiological and clinical spectrum of pancytopenia based on bone marrow examination. Materials and Methods: This descriptive study was conducted in the Department of Medicine, Dhaka medical college Hospital, Dhaka, Bangladesh over a 2-year period (August 2016 to July 2018). A total 80 cases of pancytopenia were included in the study. Patients were diagnosed by hemoglobin less than 10 gm/ dL, total leukocyte count less than 4000/Cumm and platelet count less than 150000/cumm. Results: Maximum number of cases were seen in age group of 16-30 years (31.25%) and male to female ratio is 1.1:1. The commonest presenting complaint was fever in 40% (32/80) of the cases. Pallor was present in all the patients, Splenomegaly was seen in 20% (16/80) and hepatomegaly in 12.5% of the cases (10/80). Petechial hemorrhages were present in 5% (4/80). The commonest cause of pancytopenia was megaloblastic anemia (35%) and followed by aplastic anemia (32.5%). Conclusion: Pancytopenia is a common clinical problem encountered in clinical practice and the major differential diagnostic considerations of pancytopenia are aplastic anemia, megaloblastic anemia and hematological malignancies. J MEDICINE JUL 2019; 20 (2) : 68-71

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

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)

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

2018 ◽  
Vol 6 (7) ◽  
pp. 2361
Author(s):  
Subuh Parvez Khan ◽  
Sajad Geelani ◽  
Shareefa Akhter ◽  
Shuaeb Bhat ◽  
Saleem Hussain ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Megaloblastic Anemia ◽  
Tertiary Care ◽  
Test Procedure ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Invasive Technique ◽  
Tertiary Care Centre ◽  
Female Ratio ◽  
Haematological Disorders

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.

scholarly journals Clinico hematological profile of pancytopenia in pediatric patients: an institutional experience in North Himalayan region of India

2020 ◽  
Vol 8 (2) ◽  
pp. 726
Author(s):  
Anil Rawat ◽  
Varun Mamgain ◽  
Smita Chandra ◽  
B. P. Kalra
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Megaloblastic Anemia ◽  
Nutritional Deficiency ◽  
Deficiency Anemia ◽  
Total Leukocyte Count ◽  
Mean Corpuscular Hemoglobin ◽  
Corpuscular Hemoglobin ◽  
Common Cause ◽  
Nutritional Anemia

Background: Pancytopenia is a common clinical pattern with an extensive differential diagnosis, but literature search shows only limited studies of pancytopenia in Pediatrics patients in Uttarakhand state of India. The present study was therefore conducted to study the spectrum of pancytopenia with bone marrow and haematological profile in Pediatrics patients in this north Himalayan state of India.Methods: Prospective observational study was conducted in the Department of Pediatrics in the teaching institute situated in Uttarakhand state of India over a period of 12 months. The study included all the patients of pancytopenia below 18 years of age who underwent bone marrow examination after written informed consent.Results: The study included total 50 pediatrics patients of pancytopenia with male to female ratio of 1.38:1. The mean age of patients was 10.58±4.94 with median age of 12 years. Mean hemoglobin was 5.31±2.09 g/dl, total leukocyte count was 2492.68±941.76/mm3, platelet count was 34724±26423/mm3, mean corpuscular volume was 90.95±16.65 fl, mean corpuscular hemoglobin was 30.11±6.07 pg, mean corpuscular hemoglobin concentration was 33.06±1.65% and reticulocyte count was 1.21±1.10%. Nutritional deficiency (28%) was the most common cause for pancytopenia followed by aplastic anemia (24%). Megaloblastic anemia was the commonest cause of nutritional deficiency anemia (71.42%) with pancytopenia.Conclusions: Pancytopenia is an important presentation in Pediatrics population with the most common cause being nutritional anemia and aplastic anemia. Megaloblastic anemia is the commonest cause of nutritional anemia with pancytopenia. The clinicians should be aware of spectrum of pancytopenia with clinical and haematological presentation in Pediatrics patients of this region so as to avoid unnecessary work ups and delay in treatment.

scholarly journals HAEMATOLOGICAL DISORDERS

2018 ◽  
Vol 25 (06) ◽  
Author(s):  
Muhammad Ihtesham Khan ◽  
Neelam Ahmad ◽  
Syeda Hina Fatima
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Aplastic Anemia ◽  
Hemolytic Anemia ◽  
Myeloid Leukemia ◽  
Megaloblastic Anemia ◽  
Lymphoblastic Leukemia ◽  
Deficiency Anemia ◽  
Female Ratio ◽  
Acute Myeloid

Objectives: To analyse the pattern of hematological disorders through bonemarrow aspiration, and to compare the final diagnoses with their referral diagnoses made by thereferring physicians.Study Design: Cross sectional descriptive study. Period: 1st January -2016to 30th December-2016. Setting: Department of Pathology, Khyber Teaching Hospital, Peshawar.Materials and Methods: 352 patients were included in the study. Bone marrow diagnosiswas recorded. Data was analysed by SPSS version 18 and results were drawn accordingly.Results: A total of 352 patients underwent bone marrow aspiration during the study period.About 15 patients had diluted bone marrow aspirates. So, they were excluded from the study.The remaining 337 patients were included in the study. The age of the study sample rangedfrom 9 months to 72 years (mean age 36 years ±17.8 SD). There were 185 (55%) male and151 (45%) females. Male to female ratio was 1.2:1. The commonest indication for bone marrowaspiration was “suspected malignancy”, which was suspected in 114(33.85) patients, followedby “pancytopenia”, which was seen in 69(20.55%) patients. About 69 (20.5%) patients werereferred for work up of anemia. Bicytopenia was seen in 69(20.5%). The bone marrow aspirationshowed that megaloblastic anemia was the commonest disorder observed in 37(10%) cases.Second common disorder was acute lymphoblastic leukemia, that was seen in 31 (9%) patients,followed by acute myeloid leukemia, which was seen in 26(7.7%) cases. Hemolytic anemia wasseen in 20 (15.9%) cases. Aplastic anemia was seen in 18 (5.3%) cases. Multiple myeloma andmononuclear infiltration was seen in 17 (5%) patients each. Anemia of chronic disorder wasseen in 16(4.7%) cases. Idiopathic Thrombocytopenic Purpura was seen in 12 (3.6%) patients.Iron deficiencyanemia was seen in 11 (3.3%) patients. Chronic Lymphocytic Leukemia wasseen in 10 (2.9), Mixed deficiency anemia in 9 (2.7%), Myelodysplasia in 6 (1.7%), Malaria in5(1.5%), and Niemann Pick in 4 (1.2%) patients. Gaucher disease and Visceral Leishmania wasseen in 2 (0.6%) patients each. Histiocyticlymphohistiocytosis and Chediak Hegashi syndromewas seen in 1 (0.3%) patients each. Conclusions: Megaloblastic anemia, Acute LymphoblasticLeukemia, Acute Myeloid Leukemia, Hemolytic Anemia and Aplastic Anemia are the commonhematological disorders in our set up. Bone marrow is a reliable procedure to diagnosishematological diseases when routine investigations fail to make diagnosis.

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

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

scholarly journals Bone marrow examination in cases of pancytopenia

2017 ◽  
Vol 5 (4) ◽  
pp. 1494 ◽  
Author(s):  
Pinal Shah ◽  
R. D. Patel ◽  
Bhavna Gamit ◽  
Shruti Gheewala
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Aplastic Anemia ◽  
Megaloblastic Anemia ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Round Cell ◽  
Trephine Biopsy ◽  
One Year ◽  
A Prospective Study

Background: Pancytopenia is a relatively common hematological entity. This study was undertaken to find out the various causes of pancytopenia by bone marrow examination of patients admitted to New civil hospital, Surat, Gujarat, India.Methods: This was a prospective study carried out to identify the causes of pancytopenia based on bone marrow examination. Bone marrow examinations were performed in 144 cases for different indications over a period of one year 2015, out of which 40 cases have fulfilled the criteria of pancytopenia.Results: Total 40 cases of pancytopenia were examined during period of one year. The commonest cause of pancytopenia was megaloblastic anemia (35%) followed by aplastic anemia (32.5%). other cause includes acute leukemia, myelodysplastic syndrome (MDS) and round cell tumor.Conclusions: Bone marrow aspiration coupled with trephine biopsy can diagnosed majority cases of pancytopenia. Megaloblastic anemia and aplastic anemia are the commonest causes of pancytopenia. A comprehensive clinical and hematological study of patients with pancytopenia will help in the identification of underlying cause.

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

2019 ◽  
Vol 31 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Md Rezaul Karim Chowdhury ◽  
Md Haroon Ur Rashid ◽  
Amina Begum
Keyword(s):  
Bone Marrow ◽  
Clinical Medicine ◽  
Acute Myelogenous Leukaemia ◽  
Myeloproliferative Neoplasm ◽  
Invasive Procedure ◽  
Bone Marrow Examination ◽  
Final Diagnosis ◽  
College Hospital ◽  
Female Ratio ◽  
Medicine Today

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. Materials & 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. Results: In our study male to female ratio was 1.6:1 and common age group was >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). 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. Medicine Today 2019 Vol.31(1): 15-18

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

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.

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

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

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

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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