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

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Ibtisam Abdullah ◽  
Nadhiya Subramony ◽  
Ernest Musekwa ◽  
Erica-Mari Nell ◽  
Fatima Alzanad ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Diagnostic Yield ◽  
Bone Marrow Examination ◽  
Pure Red Cell Aplasia ◽  
Diagnostic Value ◽  
Hiv Positive ◽  
Haematological Malignancies ◽  
Cross Sectional ◽  
Female Predominance ◽  
Immunodeficiency Virus

Background: Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital.Methods: A retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured.Results: Altogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients’ median age was 43 years and the interquartile range was 27–60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia.Conclusion: Bone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.

scholarly journals Bone Marrow Examination in Cases of Pancytopenia

2008 ◽  
Vol 47 (169) ◽  
Author(s):  
Abhimanyu Jha ◽  
G Sayami ◽  
R C Adhikari ◽  
A D Panta ◽  
R Jha
Keyword(s):  
Bone Marrow ◽  
Megaloblastic Anemia ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Pure Red Cell Aplasia ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Erythroid Hyperplasia ◽  
Niemann Pick

This study was carried to identify the causes of pancytopenia and to fi nd out the bone marrowmorphology in cases of pancytopenia.It was a cross sectional study conducted over a period of two years in the Department of Pathology,Tribhuvan University Teaching Hospital. Bone marrow aspiration smears of patients fulfi lling thecriteria of pancytopenia were examined. The data obtained were analyzed using measures of centraltendency.One hundred and forty eight cases underwent bone marrow aspiration and it constituted 15.74% oftotal cases. Mean age was 30 years (range, 1-79 years). 42 cases were children (28.37%). Male: femaleratio was 1.5:1. The commonest cause was hypoplastic bone marrow seen in 43 cases (29%) followedby megaloblastic anemia in 35 cases (23.64%), and hematological malignancy in 32 cases (21.62%).Erythroid hyperplasia was seen in 29 cases (19.6%) and normal bone marrow was seen in 5 cases(3.38%). There was one case each of Niemann-Pick disease and metastatic neuroblastoma in childrenand chronic pure red cell aplasia and leishmaniasis in adults. Acute leukemia was the commonesthematological malignancy. In children, commonest fi nding was hypoplastic bone marrow (38.1%)while in adults megaloblastic anemia (30.18%) was commonest fi nding followed by hypoplasticanemia (25.47%).In present study bone marrow examination was able to establish diagnosis in 77% of cases. Hypoplasticmarrow was the commonest diagnosis, followed by megaloblastic anemia, and hematologicalmalignancies.Key Words: Bone marrow aspiration, hypoplastic anemia, leukemia, megaloblastic anemia,pancytopenia

Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis

2017 ◽  
Vol 29 (2) ◽  
pp. 115-121
Author(s):  
S van Gaalen ◽  
Michael Duff ◽  
Luisa F Arroyave ◽  
Zulma Vanessa Rueda ◽  
Ken Kasper ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Diagnostic Yield ◽  
Target Therapy ◽  
Lung Infection ◽  
Morbidity And Mortality ◽  
Hiv Positive ◽  
Diagnostic Strategy ◽  
Cross Sectional ◽  
Mild Disease ◽  
Immunodeficiency Virus

Lung infection in human immunodeficiency virus (HIV)-positive individuals remains an important cause of morbidity and mortality, even in the current antiretroviral therapy era. Pneumonia is the most common cause of admission in HIV-positive individuals in our centre as reported in a previously published study. The objective of this retrospective observational study was to further characterize these admissions, with respect to index of disease severity at presentation, organisms identified, and investigations pursued including bronchoalveolar lavage (BAL). There were 123 unique patients accounting for a total of 209 admissions from 2005 to 2015. An organism was isolated in only 33% of all admissions (68/209). The most common organism was Pneumocystis jirovecii with a frequency of 29% of all admissions. Eighty-seven percent of presentations were mild, and 13% were moderate by CURB-65 criteria. A total of 39 BALs were performed, of which 27 yielded an organism (69%). Considering the burden of disease, low diagnostic yield of the current diagnostic strategy and increased morbidity and mortality caused by pneumonia in HIV-positive individuals, further methods are needed to more accurately target therapy. The preponderance of mild disease in this study suggests that better diagnostic tests may identify individuals that can be candidates for outpatient therapy.

scholarly journals Evaluation of bone marrow in patients with pancytopenia

2012 ◽  
Vol 2 (4) ◽  
pp. 265-271 ◽  
Author(s):  
R Pathak ◽  
A Jha ◽  
G Sayami
Keyword(s):  
Bone Marrow ◽  
Hematological Malignancies ◽  
Diagnostic Yield ◽  
Megaloblastic Anemia ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Clinical Findings ◽  
Trephine Biopsy ◽  
Cross Sectional ◽  
Hypoplastic Anemia

Background: Pancytopenia is a common hematological finding resulting from varieties of disease processes that require evaluation of bone marrow. This study was carried out to evaluate bone marrow findings in patients presenting with pancytopenia.Materials and Method: This was a prospective cross sectional study carried out to identify the causes of pancytopenia based on bone marrow examination. Bone marrow examinations were performed in 503 cases for different indications over a period of one year.Results: One hundred and two (20.27%) cases fulfilled the criteria of pancytopenia. Trephine biopsy was possible only in 48 cases. In 75% cases aspiration findings were similar to biopsy. Mean age of patients was 38.8 years. Maximum number of cases was seen in age group of 15-30 years. Hypoplastic anemia was the commonest cause followed by hematological malignancies, megaloblastic anemia, leishmaniasis and Gaucher disease. Bone marrow examination alone was able to establish the diagnosis in 76.5% cases. In rest marrow findings were nonspecific and in 4.9% cases findings were normal.Conclusion: Bone marrow aspiration coupled with trephine biopsy can diagnose majority but not all the cases of pancytopenia. Hypoplastic anemia, hematological malignancies and megaloblastic anemia are the commonest causes of pancytopenia. Maximum diagnostic yield can be achieved by correlation with clinical findings, peripheral blood findings and with other laboratory and radiological parameters.Journal of Pathology of Nepal (2012) Vol. 2, 265-271DOI: http://dx.doi.org/10.3126/jpn.v2i4.6875

scholarly journals Retrospective comparison of cytological and histological bone marrow morphology in adult antiretroviral-naïve and antiretroviral experienced human immunodeficiency virus-infected patients with peripheral blood cytopaenias

2016 ◽  
Vol 31 (2) ◽  
pp. 50-56
Author(s):  
Suraya Naidoo ◽  
Vincent L. Naicker
Keyword(s):  
Bone Marrow ◽  
Human Immunodeficiency Virus ◽  
Pure Red Cell Aplasia ◽  
Morphological Features ◽  
Hiv Positive ◽  
Retrospective Comparison ◽  
Immunodeficiency Virus ◽  
One Year ◽  
Compare And Contrast ◽  
Positive Population

Background: A cohort of human immunodeficiency virus (HIV)-positive patients presenting to a quaternary hospital in KwaZuluNatal, South Africa over a period of one year was identified and morphological analyses of their bone marrow aspirates and trephine biopsies (BMAT) undertaken.Aim: To compare and contrast the bone marrow morphological features of antiretroviral (ARV)-naïve and ARV-experienced HIV-positive population with cytopaenias; correlate the findings with CD4 counts; and, draw conclusions on whether ARV are associated with specific bone marrow (BM) findings.Method: Aspirate and trephine biopsy examinations to assess dysplasia of cell lineages, architectural changes, granulomas or infiltrates were performed by light microscopy.Results: 74 BMAT were examined, of which 24 were from the ARV-naïve cohort and 50 from ARV-treated cohort. Within granulomas, higher rates of marrow infiltration by acid-fast bacilli was present in the ARV-naïve cohort than the ARV-experienced cohort (6/10 (60%) versus 9/26 (35%), respectively). Higher rates of pure red cell aplasia (PRCA) were detected in the ARV-experienced than the ARV-naive cohort (14% versus 4%, respectively). No difference was seen in morphological features and overall dysplasia rates (70% and 71% of ARV-naïve and ARV-experienced cohort, respectively). At CD4 200 cells/ul, higher rates of dysplasia were seen in the ARV-naïve cohort (3/3 (100%) than in the ARV-experienced cohort (13/20 (65%)).Conclusion: Similar dysplasia rates and morphological features in both cohorts suggest ARVs do not cause myelodysplasia. BM tuberculosis is more frequently detected in granulomas of ARV-naïve than ARV-experienced samples. ARVs are implicated in causation of PRCA.

scholarly journals A High Prevalence Rate of a Positive Screen for Cognitive Impairment in Patients With Human Immunodeficiency Virus Attending an Irish Clinic

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Patricia H. McNamara ◽  
Robert Coen ◽  
Janice Redmond ◽  
Colin P. Doherty ◽  
Colm Bergin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cognitive Impairment ◽  
Large Scale ◽  
Screening Program ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Study Cohort ◽  
Cross Sectional ◽  
Positive Screen ◽  
Immunodeficiency Virus

Abstract Background Human immunodeficiency virus (HIV)-associated neurocognitive disorders occurs in 20%–50% of HIV-positive patients. We undertook this study to assess the prevalence of a positive screen for cognitive impairment in the clinic population at our institution and to demonstrate the feasibility of implementing a screening program in routine clinical encounters. Methods This was a cross-sectional study, and patients were recruited prospectively between December 2010 and February 2013. Inclusion criteria were as follows: patients were HIV positive, over the age of 18, capable of giving informed consent, and had sufficient ability to communicate in English. Patients were screened for cognitive impairment using the Brief Neurocognitive Screen. Results A total of 604 patients were recruited, and 51.5% had a positive screen for cognitive impairment. The majority of the study cohort were male (78.8%), mean age was 40.9 (standard deviation, 10.2) years, 70.9% were Irish, the most common mode of transmission was men who have sex with men (49.3%), 83% were on antiretroviral therapy, and 88.7% were virally suppressed. Logistic regression showed that the main factors predictive of a positive screen for cognitive impairment were the endorsement of cognitive symptoms (P = .024), being born in Africa (P < .000001), the use of benzodiazepines (P = .00341), being unemployed (P = .008), and consumption of more than 40 units of alcohol weekly (P = .035). There was a positive screen for depression in 9.1% and a positive screen for anxiety in 24.5%. Conclusions The study highlights the necessity for a structured, prospective, large-scale screening program for cognitive impairment across countries with limited resources and demonstrates the feasibility of easily implementing this with minimal training.

scholarly journals Prevalence and predictors of dyslipidemia on HAART and HAART naive HIV positive clients attending Debre Tabor Hospital, Debre Tabor, Ethiopia

2021 ◽  
Author(s):  
Anemut Tilahun Mulu ◽  
Getachew Yideg Yitbarek ◽  
Fitalew Tadele Admasu ◽  
Chalachew Yenew Denekew ◽  
Biruk Demissie Melese
Keyword(s):  
Venous Blood ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Anthropometric Measurement ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Immunodeficiency Virus ◽  
Debre Tabor ◽  
The Mean ◽  
Cd4 Cell

Abstract Background: HAART has been reported to be associated with a number of side effects in human immunodeficiency virus patients among which dyslipidemia is a common metabolic disorder. Methods: A facility based comparative cross-sectional study among 228 HIV positive persons was conducted from July to August 2020. Socio-demographic and clinical data were collected using structured questionnaires. Fasting venous blood sample was drawn for Lipid profiles and CD4 cell determination. Anthropometric measurement was done. Data was analyzed using SPSS version 22 for windows. Result: A total of 228 HIV patients were enrolled in the study. Prevalence of dyslipidemia in HAART naive and on HAART HIV positive persons was 61(53.5%) and 84 (73.7%), respectively. The prevalence of TC≥200 mg/dl was 50% and 30%; HLD-c<40 mg/dl was 43.8% and 36%; LDL-c≥130mg/dl was 48.3% and 28.1%; and TG≥150 mg/dl 59.6% and 39% among on HAART and HAART naïve, respectively. Age greater than 40 years (AOR = 3.27, 95% C.I: 1.47 - 7.25), blood pressure ≥ 140/90 (AOR = 16.13, 95% C.I: 5.81 - 44.75), being on HAART (AOR = 2.73, 95 % C.I: 1.35 - 5.53) and body mass index > 25kg/m2 (AOR = 1.92, 95 % C.I: 1.20 - 4.81) were identified as determinants of dyslipidemia. Conclusion: The mean value of lipid profile was significantly higher among HIV positive clients on HAART as compared to those HAART naïve HIV positive clients.

scholarly journals Dentition status and treatment needs of human immunodeficiency virus-positive patients on anti retro viral therapy in Raichur taluk, Karnataka, India: A cross sectional study

2017 ◽  
Vol 11 (02) ◽  
pp. 238-241 ◽  
Author(s):  
Shrikanth Muralidharan ◽  
Arunkumar Acharya ◽  
Shanthi Margabandhu
Keyword(s):  
Dental Caries ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Sectional Study ◽  
Treatment Needs ◽  
Cross Sectional ◽  
Viral Therapy ◽  
Immunodeficiency Virus ◽  
Study Population ◽  
Convenience Sampling

ABSTRACTObjective: The aim of the study was to assess the dentition status and the treatment needs of the HIV-positive patients on ART for more than a year in Raichur, Karnataka. Materials and Methods: Convenience sampling was followed. The sample size was 170. The dentition status and treatment needs of the patients were recorded as per the WHO guidelines. Results: The overall prevalence of dental caries was 79.4%. Males had higher percentage of dental caries than the females, and this was found to be statistically significant. The prevalence of dental caries was higher among the participants who used finger to clean their teeth compared to the toothbrush, neem stick, and charcoal users, and this was found to be statistically significant. Conclusion: Higher prevalence of dental caries was observed among the study population. Most of them required some type of treatment. Patients with a low CD4 count required higher treatments than the others.

scholarly journals A Clinico-Haematological Study of Causes of Pancytopenia

2021 ◽  
Vol 10 (40) ◽  
pp. 3533-3537
Author(s):  
Arvind Chouhan ◽  
Fuzail Ahmad ◽  
Manisha Jain
Keyword(s):  
Bone Marrow ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Bone Marrow Examination ◽  
Care Hospital ◽  
Cross Sectional ◽  
Smear Examination ◽  
Cellular Components ◽  
Haematological Study

BACKGROUND This is a clinic-haematological study, conducted in Sidhanta Hospital, Bhopal, to identify the causes of pancytopenia. Out of total 1200 cases of complete hemograms, 56 cases were categorized as pancytopenias, and out of these, 24 cases were subjected to bone marrow examination. The remaining 32 cases of pancytopenia, were put on periodic follow up with peripheral blood smear examination, based on clinical data. Pancytopenia is the simultaneous presence of anaemia, leucopenia and thrombocytopenia that may result from various disease processes, involving the bone marrow primarily or secondarily. Pancytopenia is reduction in all the three cellular components of the blood, namely red blood cells (RBCs), leucocytes (WBCs) and platelets. It is a common entity which is encountered by practitioners. The presentation is in the form of cytopenias leading to infections, anaemia, or bleeding manifestations. All the cases of pancytopenia need a through approach to reach to the cause of the same so that it can be managed in the best possible manner. Cytopenias are reduction in any of the three cellular components of the blood i.e. RBCs, WBCs or platelets. It can be reduction in two cellular components (bicytopenia) or a reduction in all the three cellular components (pancytopenia). In bicytopenia, the most common combination to be seen is anaemia and thrombocytopenia, whereas the least common is leucopenia with thrombocytopenia. (1) For practical purposes, it should have haemoglobin < 10 g%, absolute neutrophil count < 1,500/cumm and platelets < 1,00,000/cumm. It is labelled as severe when the three values are < 7 g%, < 500/cumm and < 20,000/cumm respectively. The purpose of this study was to find out different causes of pancytopenia and the use of bone marrow examination in evaluation of pancytopenia. METHODS This is a cross sectional study, conducted exclusively in the Department of Medicine, at a tertiary care hospital, in Bhopal from August 2019 to December 2019. A total of 56 cases of pancytopenia were analysed with clinico-haematological features. Criteria for diagnosis of pancytopenia were: Haemoglobin less than 10 gm/dl, TLC less than 4000/mm3 and platelet count less than 1,00,000/mm3. We have correlated the complete hemogram findings with bone marrow examination (if required) and peripheral smear examination in order to analyse the root cause of every case of pancytopenia. Pancytopenia is a haematological entity, we have to analyse the cause of it in order to find out the correct diagnosis and treat the patient accordingly. Bone marrow examination is useful in the investigation of PUO (pyrexia of unknown origin), as it leads to an etiological diagnosis in many of the cases. RESULTS In these 56 cases, only 24 cases (42.85 %) were subjected for bone marrow examination. Commonest cause of pancytopenia was episode of viral fever constituting 28 cases (50 %). CONCLUSIONS In cases of PUO, bone marrow examination is a very useful investigation. In cases diagnosed as idiopathic thrombocytopenic purpura (ITP), when the patient does not show improvement in counts, a repeat bone marrow examination should be done, as very rarely; acquired amegakaryocytic thrombocytopenia may be the cause. Though bone marrow examination is an absolute indication in cases of pancytopenia, it is important to wait for at least 2 – 3 weeks, and do a repeat hemogram, especially in cases of viral fever where the counts usually improve after fever subsides. KEY WORDS Pancytopenia, Bone Marrow, Viral Fever

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