Clinico-hematological evaluation in cases of pancytopenia at tertiary care centre: largest cross-sectional study

Background: Pancytopenia is characterised by a reduction in all the three cellular elements of blood (erythrocytes, leukocytes and platelets) below the normal reference range leading to anaemia, leucopenia and thrombocytopenia. It is a feature of many serious conditions. The present study was conducted to assess aetiology, clinical profile and bone marrow morphology of conditions presenting with pancytopenia.Methods: A two years cross-sectional study from July 2017 to June 2019 was conducted in the Department of Pathology. Total of 300 pancytopenia patient were studied and their clinical features, peripheral smear finding and bone marrow morphology were studied by using marrow aspiration and biopsy.Results: Among 300 cases studied, maximum patients were in the age group 11-20 years (19.66%) with male (50.66%) predominance. Most of the patients presented with weakness (91.66%) and fever (56.66%) as chief complains. The commonest physical finding was pallor (94%) followed by splenomegaly (27.33%). Macrocytic anaemia (43.66%) was commonest peripheral finding. The commonest cause of pancytopenia was megaloblastic anaemia (32.66%) followed by dimorphic anaemia (21%), aplastic anaemia (16%) and acute leukaemia (13.33%).Conclusions: The present study concludes that detailed clinical history, primary haematological investigations along with bone marrow examinations is essential to determine the cause of pancytopenia.

Correlation of Bone Marrow Morphology and Immunophenotyping in Acute Leukaemia Patients

Background: Acute leukaemia (AL) is a malignant disorder of the blood that is characterized by blocked or impaired differentiation of haemopoietic stem cells, resulting in abnormal accumulation of immature precursors and suppression of growth and maturation of cells in vivo. Objective: To find out correlation between morphological and immunophenotypic study of bone marrow among acute leukaemia patient. Methods/Procedure: This is a comparative cross sectional study of diagnosis of leukaemia by bone marrow study and immunophenotyping from bone marrow sample with bone marrow alone of suspected cases of leukaemia treated in the department of haematology in Dhaka Medical College Hospital (DMCH)from March 2013 to August 2013 .Bone marrow examination and immunophenotyping was done simultaneously but having bone marrow morphology report we have compared with flow report. Results: Out of 50 patients according to Bone marrow study (BMS) 25(50.0%) of the patients had acute myelogenous leukaemia, 24(48.0%) had acute lymphoblastic leukaemia and 1(2.0%) had acute leukaemia. On the other hand, in immunophenotyping 28(56.0%) patients had acute lymphoblastic leukaemia, 20(40.0%) had acute myelogenous leukaemia and 2(4.0%) mixed cell immunophenotyping. Discordance of diagnosis was found in 3(6%) is diagnose as AML which was ALL on flow and one acute leukaemia and one AML was subsequently diagnose as mixed cellular leukaemia. Conclusion: Subjective variation in the accuracy of diagnosis of leukaemia on the basis of bone marrow study alone may occur. Inclusion of immunophenotyping with bone marrow study improves accuracy of leukaemia.

Frequency of Discrepancy between Bone Marrow Morphology and Immunophenotype in Acute Leukaemia

Background: Acute leukaemia (AL) are a heterogenous group of haematological malignancy characterized by uncontrolled clonal proliferation of haematopoietic progenitor cells. Objectives: The study was conducted to have a detailed understanding of immunophenotyping profile, the frequency of discrepancy between bone marrow morphology and immunophenotyping and importance of immunophenotyping in diagnosis of acute leukaemia. Methods: This prospective type of observational study was carried out with an aim to correlate the immunophenotype with bone marrow morphology and to see the discrepancy between this two in acute leukaemia. A total of 38 untreated acute leukemia patients attending in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period from October 2016 to September 2017were included in this study. At first the morphological diagnosis was done. Then the immunophenotypic profile was compared. Result: Around eighty-two cases of acute leukaemia did find similarity with immunophenotyping and remaining 18.4% shows discrepancy. Diagnosis in this 18.4% changes after immunophenotyping. Aberrant phenotypes were detected in 20 (52.6%) samples among them 13 (34.21%) cases were AML, 3 (7.8%) cases were B-ALL and 4 (10.52%) cases were T-ALL. Significant relation was not found between aberrant marker and FAB subtypes. Conclusion: In acute leukaemia morphological appearance of bone marrow does not always match with immunophenotyping. It is therefore imperative and absolutely essential to ascertain the lineage of leukaemia by immunophenotyping before starting treatment.

Effect of Imatinib on Bone Marrow Morphology and Angiogenesis in Chronic Myeloid Leukemia

Background and Objectives. Chronic myeloid leukemia (CML) is characterized by hyperproliferation of myeloid precursors, increased fibrosis, and neoangiogenesis in the bone marrow. Imatinib inhibits BCR-ABL tyrosine kinase produced due to reciprocal translocation t(9;22) in neoplastic CML cells. It reduces hyperproliferation of myeloid precursors and has been found to affect bone marrow fibrosis and angiogenesis. This study was done to assess the effect of imatinib on bone marrow morphology and angiogenesis in CML. Methods. 31 newly diagnosed CML patients were evaluated before and after 3 months of imatinib therapy. A marrow morphological response (MMR) score was used to assess marrow cytological and histological features including grade of fibrosis. Mean microvessel density (MVD) was also assessed. Hematological parameters and BCR-ABL transcript levels were assessed in the peripheral blood. Results. 86.21% of patients showed decrease in marrow cellularity with normalization of M:E ratio. 72.42% of patients had decrease in grade of fibrosis and 17.24% showed no change while 10.34% of patients showed progression of fibrosis grade. Patients with MMR score ≥ 2 (n=4) and those with progression of fibrosis grade (n=3) showed suboptimal molecular response (BCR-ABL transcripts > 10%). Pretherapy mean MVD of patients (14.69 ± 5.28) was higher than that of controls (6.32 ± 1.64). A significant reduction of 66.51% was observed in posttherapy mean MVD (4.98 ± 2.77) of CML patients (p<0.001). Conclusion. Imatinib therapy in CML not only decreases marrow cellularity, but also helps towards normalization of bone marrow microenvironment by reducing fibrosis and angiogenesis.