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Background: Pancytopenia is one of the most common clinico-haematological entity observed in our day to day clinical practice. It is a disorder in which all the three major elements of blood (i.e. red blood cells, white blood cells and platelets) are decreased in number. The causes of pancytopenia may be due to decrease in hematopoietic cell production in the marrow resulting from infections, toxins, malignant cell in?ltration, post- chemotherapy or post-radiation. Aims and Objectives: 1) To study the etiology and clinical presentation of pancytopenia in all age groups. 2) To correlate with bone marrow interpretation Materials & Methods: This is a prospective study which was conducted among 50 patients of pancytopenia in the Clinical Pathology, Government General Hospital,Kurnool from January 2021 to October 2022 Bone marrow aspiration was done by using Salah's bone marrow puncture needle. Smears were made from bone marrow aspirate (BMA) and stained by Leishman stain and special stains like Perl`s wherever necessary. The smears were assessed for cellularity, differentiation and maturation of erythroid, myeloid and megakaryocytic lineage, M:E ratio, Plasma cells, Lymphocytes and parasites/ abnormal cells. In the present study the commonest cause of Pancytopenia was Megaloblastic anemia (70%) followed by Results: Dimorphic anemia (20%). The less common conditions were Multiple Myeloma (6%),Chronic Myeloid Leukemia(2%),Acute Leukemia(2%). The present study concludes that complete primary hematological Interpretation and Conclusion: investigations along with bone marrow aspiration in pancytopenic patients are helpful for understanding disease process and to diagnose or to the rule out causes of pancytopenia. These are also helpful in planning for further investigations and management
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Anemia is a common symptom of haematological disorders in people of all ages .The spectrum of haematological disorders differs significantly between developing and industrialized countries. The primary use of bone marrow aspirate is for cytological examination. It enables study into the cellularity of the bone marrow as a whole, the detection of specific lesions, and the amount of infiltration by various disease entities. The aim of the study is toAims & objective: evaluate the spectrum of haematological disorders reported in bone marrow aspiration and to know the age and sex incidence. This prospective study is an observational study was conducted over a one-yearMaterials and methods: period on 73 patients and the spectrum of hematological disorders was studied on bone marrow aspiration smears. Conclusion: A thorough examination of the bone marrow is essential for diagnosing haematologic disorders. It is a simple and cost effective procedure which can be performed routinely without using any specialized equipment or a need of general anaesthesia
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Objective:To study the morphology of hemophagocytosis (HPC) in bone marrow smears of patients with infection-associated hemophagocytic lymphohistiocytosis (IAHLH), and further analyse if there were differences in the clinical and laboratory features, the cytokines level and prognosisMethods:24 patients newly diagnosed with IAHLH from 2016-Dec-1 to 2021-Dec-31 in Beijing Friendship Hospital were included as study group, and 20 patients with infectious disease as non-HLH control group. In IAHLH group, mean age was 34±13 years, including 17(71%) males and7(29%) females. In Non-HLH group, mean agewas 43±16 years, including 14 (70%) males and6 (30%) females. Depending on re-checking phagocytic cell type on the initial bone marrow smear, the HPCs were divided into HPC-1, phagocytizing non-nucleated cells (mature erythrocyte or platelets), and HPC-2, phagocytizing nucleated cells. The differences in clinical presentations covered in HLH-2004 criteria, cytokines value(IL-6, IL-10, IL-18, IFN-γ) recommended in HLH-2022-China guideline, and the mortality within 1 year of diagnosis, were compared between IAHLH and non-HLH groups, between patients with or without HPC, and between patients with HPC-2 or only with HPC-1. For categorical variables, two groups were compared with the use of either the chi-square test or Fisher′s exact test. For non-normal distribution continuous variables, the difference between two groups variation was performed by using Mann-Whitney U test, and for normal distribution continuous variables, the difference was by the Independent Samples t-test.Results:The positive rates of fever, hepatomegaly and splenomegalyand the motrtality in IAHLH were 100% (24/24), 63% (15/24), 92% (22/24) and 46% (11/24), respectivelyin non-HLH were 55%(11/20),0(0/20),25% (5/20),0(0/20),and the differences between two groups were all statistically significant( P<0.01), but thedifferences between groups with and without HPC and between IAHLH patients with HPC-2 or only with HPC-1 were no statistically significanlly, ( P>0.05).In IAHLH group, IFN-γ in patients with HPC-2 was 400(246, 532)ng/L, significantly higher than 146(38, 180)ng/L in patients only with HPC-1 [ P=0.02, 95% CI was 233(75.8 to 397)], andthe other test parameters and cytokines level showed no obvious differences ( P>0.05).
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Background and Objectives: Currently, one of the most useful prognostic indicators in Ewing sarcomas (ES) is the presence of metastatic disease at diagnosis. According to various clinical guidelines, the assessment of bone marrow (BM) metastases, using light microscopy examination of bone marrow aspirates and biopsies (BMAB) is mandatory. However, the prognostic value of BM positivity is discussed controversially. Therefore, the primary aim of this study was to retrospectively review BM samples from patients with ES. Materials and Methods: This retrospective single centre study included 31 patients that were newly diagnosed with ES between 2000 and 2014. Twenty-seven patients had skeletal ES and in 4 patients the tumour was localized in the soft tissue only. Metastases at diagnosis were present in 5 out of 31 patients. BM samples were morphologically and immunohistochemically searched and screened for the presence or absence of BM metastases. Furthermore, in 15 of the 31 patients BM samples were still available and were reanalysed, using nested-polymerase chain reaction. Results: All BM samples of our 31 ES patients, including the 5 metastatic patients, were, morphologically and immunohistochemically tested negative for tumour cell appearance. The nested-PCR results were also negative in all of our 15 retested patients, including two patients with metastatic disease. Conclusions: Based on our results and on the contradictory results reported in the literature we recommend a re-evaluation of the necessity and the prognostic value of BMAB in the initial staging process of newly diagnosed ES patients
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Background: For diagnosis of haematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow imprint (BMI) and bone marrow biopsy (BMB). BMA gives cytological picture; BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above modalities. The study was conducted with the aim to perform cytomorphological evaluation of bone marrow in various haematological disorders with special reference to leukaemia and lymphoma and to compare bone marrow aspiration smears with bone marrow trephine biopsy.Methods: The present study was conducted in department of pathology, LLRM Medical College, Meerut inpatients attending the outpatient department and in-patient department of pediatrics and medicine of SVBP Hospital attached to LLRM Medical College, Meerut, over a period of one year i.e. from March 2018 to May 2019. A detailed clinical history, physical examination and laboratory examination of all the cases was done.Results: Out of 50 cases, maximum number of cases were of anemia 26/50 (52%) followed by leukemia 17/50 (34%), lymphoma 5/50 (10%), multiple myeloma 1/50 (2%), myelofibrosis 1/50 (2%), leishmaniasis 1/50 (2%) and idiopathic thrombocytopenic purpura 1/50(2%). BMA smears were compared with biopsy and concordance and discordance was established. The overall diagnostic accuracy of aspiration was 94%.Conclusions: Bone marrow examination is a safe, quick easy and cost-effective procedure with very less patient discomfort. BMA shows better cellular details when compared to BMI and BMB. BMB is diagnostic investigation in dry tap cases like aplastic anemia, myelofibrosis, myelodysplastic syndrome and metastatic tumors. In present study, concordance between BMA and BMB was seen in majority of the cases and diagnostic accuracy was 94% study concludes that bone marrow aspiration cytology and trephine biopsy complement each other and should be performed simultaneously for complete bone marrow work up and evaluation.
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Introduction: Inspection of the bone marrow is considered oneof the most valuable diagnostic tool to evaluate hematologicmalignancies. This study compares all three techniques ofbone marrow aspiration (BMA), bone marrow imprint (BMI)and bone marrow biopsy (BMB) in morphological diagnosisof hematological malignancies.Material and methods: The study was conducted on 63selected cases of various hematological malignancies. Onlythose cases in which bone marrow examination was done byusing all the three techniques were included in the study.Results: Out of total 63 cases,53 cases were diagnosed onbone marrow aspirate smears with diagnostic accuracy of84.12%, 60 cases were diagnosed on bone marrow imprintsmears with diagnostic accuracy of 95.23% and all 63 caseswere diagnosed on bone marrow biopsy with diagnosticaccuracy of 100%.Conclusion: It is concluded that bone marrow imprintsare equally useful as bone marrow biopsy in diagnosinghematological malignancies. Imprint cytology shouldtherefore be a standard practice for evaluating bone marrow incases of hematological malignancies.
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Background: Pancytopenia is reduction of all three formed elements of blood below the normal reference range leading to anemia, leucopenia, thrombocytopenia. Bone marrow aspiration is extremely helpful in evaluating the cause of pancytopenia by cellularity and cytology in order to prevent grave complications and mortality as the underlying pathology determines the management and prognosis of the patients. Aim of research study was to evaluate the patients having pancytopenia at tertiary care center, M.Y.H. Hospital, Indore, India.Methods: The present study was carried out over a period of one year from 2017 to 2018, in the Department of Pathology, M. Y. Hospital, Indore. During this period, a total of 109 bone marrow smears were examined. Out of these, 42 cases had the clinical presentation of pancytopenia. A detailed study was done regarding clinical examination and hematological and radiological investigations.Results: In this study 42 cases of pancytopenia were examined over a period of one year. The commonest cause of pancytopenia was megaloblastic anemia (33.34%) followed by aplastic anemia (19.05%). Others includes myelodysplastic syndrome (MDS), acute leukemia, erythroid hyperplasia and plasmacytosis.Conclusions: Bone marrow aspiration can diagnose majority of the cases of pancytopenia. Megaloblastic anemia and aplastic anemia are the commonest causes of pancytopenia.
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Background: Pancytopenia refers to combination of anaemia, leukopenia and thrombocytopenia. It may be a manifestation of a wide variety of disorders, which primarily or secondarily affect the bone marrow. However, aetiology of pancytopenia varies from one geographical region to another. Bone marrow aspiration plays an important role in identifying the cause of pancytopenia. This study was carried to identify the causes of pancytopenia and to find out the bone marrow morphology in cases of pancytopenia.Methods: This study was conducted in the department of haematology in a tertiary care center in Kashmir valley for a period of 3 years. Inclusion criteria: cases with hemoglobin less than 10 gm/dl, total leucocyte count of less than 4000/mm3 and platelet count less than 100,000/mm3 were included in the study.Exclusion criteria: Patients receiving chemotherapy/radiotherapy were excluded from the study. Bone marrow aspiration (BMA) was performed from posterior iliac crest of the patients. Bone marrow aspiration smears were stained with Leishman stain for microscopy.Results: A total of 334 cases were studied during a period of 3 years. Age of patients ranged from 1 year to 85 years with mean of 43.59 years.180 cases were male, and 154 cases were female with male:female ratio of 1.2 :1. The commonest cause of pancytopenia was megaloblastic anemia seen in 103 cases (30.8%) followed by dual deficiency anemia seen in 69 cases (20.7%).37 cases (11%) were of acute leukaemia. Aplastic anemia was seen in 35 cases(10.5%). Other causes of pancytopenia were myelodysplastic syndrome, multiple myeloma, iron deficiency anemia and hypersplenism.Conclusions: Bone marrow aspiration in patients of pancytopenia helps in the identification of the underlying cause in most of the cases. BMA is helpful for understanding the disease process; and in planning further investigations and management of cytopenia patients.
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Generally patients suffering from leukemia complain of very vague symptoms of low grade fever for 2-3 months, weight loss, loss of appetite, fatigue, recurrent infections, petechiae in the body. Thus high index of suspicion and proper diagnosis is needed. The patients who attend tertiary care centre with above symptoms should be initially diagnosed by doing complete blood count, peripheral blood smear examination followed by bone marrow aspiration and its examination. It provides high quality visualization of cell morphology and enables differential count. A total of 1793 patients attended Department of Pathology in the tertiary care centre for bone marrow examination. Of this majority of cases were diagnosed with erythroid hyperplasia with megaloblastic reaction. 152 cases were diagnosed with leukemias. There were 66 cases of ALL, 46 cases of AML, 35 cases of CML, 3 cases of CLL and 2 cases of CEL. Few cases of Multiple Myeloma, plasma cell dyscrasias and immune thrombocytopenic purpura were diagnosed. In this study, we have analysed the incidence of different types of leukemia in different age groups and their presenting sign and symptoms
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Introduction: For diagnosis of hematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow biopsy (BMB) and touch imprint cytology (BMI). BMA gives cytological picture, BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as bone marrow architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above three modalities. Material and methods: The present study was a prospective study done from January 2013 to December 2013. Total 51 cases, where BMA, BMI and BMB were performed on OPD and IPD patients at Dhiraj General Hospital, Vadodara were included. Complete clinical data were recorded including physical examination, complete hematological study along with other relevant investigations and proforma filled. Results: The various diseases diagnosed by BMA, BMI and BMB were megaloblastic anemia (19.6%), aplastic/ hypoplastic anemia (13.7%), iron deficiency anemia/ micronormoblastic erythroid hyperplasia (2.0%), dimorphic anemia (5.9%), idiopathic thrombocytopenic purpura (2.0%), plasma cell dyscrasias (3.9%), Myeloproliferative disorders (3.9%), leukemia (15.7%), normocellular marrow (13.7%), metastasis (15.7%) and miscellaneous (3.9%). Conclusion: BMA is found to be the superior procedure for evaluation of hematological disorders compared to BMI and BMB.
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Background: Bone marrow examination is useful in the diagnosis of both hematological and non-hematological disorders. The two most important techniques used for the diagnosis of hematological disorders are bone marrow aspiration and trephine biopsy which are complementary to each other. The present study is to evaluate the findings of bone marrow aspiration & trephine biopsy and their cytological and histological patterns in various hematological disorders. The aim of the study is to evaluate the clinical profile, spectrum, cytological and histological pattern of various hematological disorders reported in bone marrow aspiration and trephine biopsy respectively. Methods: It was a cross-sectional study design with 105 patients who underwent bone marrow examination for evaluation of hematological disorders in the Department of pathology, Andhra Medical College during the period of 2012 to 2014. Results: Among 105 cases studied, age of patients ranged from 1 to 68 yrs with mean age of 32.4 yrs and male predominance (1.5:1). Most of the patients presented with fever, shortness of breath, Easy fatigability and generalized weakness. The commonest physical findings were pallor followed by splenomegaly & hepatomegaly and in hematological parameters predominantly pancytopenia. Bone marrow aspiration was diagnostic in 53(50%) cases and trephine biopsy was diagnostic in 52(50%) cases. Anemias (50%) and leukemias (16%) are most common hematological disorders. Among the anemias, megaloblastic anemia is the most common (40%) cause of hematological non-malignancies. Among leukemias, acute myeloid leukemias are common cause of hematological malignancies. Conclusion: The present study showed the usefulness of bone marrow aspiration and trephine biopsy in evaluation of the bone marrow in routine haematological disorders and also for understanding disease progression, for diagnosis and therapeutic evaluation. These are also helpful in planning further investigation and management.
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Bone marrow aspiration (BMA) is much more frequently used than bone marrow biopsy (BMB) in the diagnosis of different haematological disorders. BMB is performed primarily in cases where bone marrow aspiration either fails or gives insufficient information. It is the sole modality of diagnosis in some situations and may give useful information of prognostic importance. The present study was done to find comparative usefulness of each of these procedures in various hematological disorders. Methods: Study subjects included all 45 patients attending the hematology section of pathology department of College of Medicine & Jawaharlal Nehru Memorial Hospital, Kalyani for bone marrow aspiration and who also consented for bone marrow biopsy during the period from 1st July 2011 to 30th June 2012. BMA smears and BMB specimens were obtained from posterior superior iliac spine in the same sitting and stained with Leishman’s stain and Haematoxylin & Eosin stain respectively. Findings of BMA and BMB were compared. Results: BMA was diagnostic in all cases of iron deficiency anemia (IDA), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), idiopathic thrombocytopenic purpura (ITP) and essential thrombocythemia (ET). On the whole, BMA was diagnostic in 82.2% of cases and could accurately reveal hypercellularity in all cases. BMB was the only diagnostic method in myelofibrosis (MF) and provided additional information like fibrosis in cases of AML, CML and MF & pattern of involvement in CLL and multiple myeloma (MM). BMB, however, was poor in assessing iron stores due to leaching of iron during decalcification. Conclusions: BMA alone is sufficient for IDA and ITP. BMB is mandatory for diagnosis of MF and provides additional prognostic information in other cases.
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Biopsy/methods , Biopsy, Needle/methods , Bone Marrow Examination/methods , Hematologic Diseases/classification , Hematologic Diseases/diagnosis , Hematologic Diseases/pathology , Humans , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/pathology , Thrombocythemia, Essential/diagnosis , Thrombocythemia, Essential/pathologyABSTRACT
Background: Bone marrow aspiration is an essential but hazardous procedure. We have developed a mannequin simulator with posterior iliac crests to teach needle puncture.<br>Method: After watching a video demonstration of bone marrow aspiration, undergraduate medical students were asked to complete a questionnaire concerning their calmness （C） and self-confidence （S） in performing the procedure using 5-point rating scales （1–5: worst–best） and its estimated ease （E） （1-5: difficult–easy）. The students were given hands-on, small-group instruction using the simulator and allowed to practice, after which they were asked to answer the questionnaire again. The outcome was a change in scores between before and after practice. The paired Student’s t-test （two-tailed） was used for statistical analysis. We also evaluated correlations between pairs among 3 factors.<br>Results: The participants were 200 fifth-year student volunteers from Kawasaki Medical School. The scores after instruction and practice were higher than those before （C: 1.57±0.85 vs. 2.61±1.27; S: 1.61±0.85 vs. 2.86±1.01; and E: 2.36±1.13 vs. 3.65±1.11）. Estimated ease was moderately correlated with self-confidence in performing the procedure after instruction and practice, and the rank-correlation coefficients of before and after were 0.481 and 0.557, respectively. The coefficients of C and E before and after the instruction and practice were 0.346 and 0.526, respectively, whereas the coefficients S and C were 0.487 and 0.414, respectively.<br>Discussion: Simulator-based training may reduce medical students’ anxiety about bone marrow aspiration and its estimated difficulty.
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Background: A bone marrow evaluation encompasses bone marrow aspirate (BMA) and bone marrow biopsy (BMB) along with a review of peripheral smear examination. However, due to variations in practice, bone marrow core biopsy is not performed for all patients. Aim: To compare the diagnostic utility of simultaneous BMA and BMB and to study the concordance rate between the two. Material and methods: All BMA and BMB that were simultaneously done between January 2008 and December 2010 in a multispecialty hospitals were reviewed and analyzed in detail. Results: Four hundred sixty-six aspiration and biopsy slides were reviewed. The commonest indication was anemia (40.3%) followed by pyrexia of unknown origin (36.2%); 15.2% aspirates and 6.4% biopsies were inadequate. The overall concordance rate between aspirates and biopsy was found to be 62.8%. Concordance was highest for acute and chronic leukemias, metastatic deposits, multiple myeloma and tuberculosis and least for lymphoproliferative disorders, myelofibrosis and marrow hypoplasia. Trephine biopsy was useful for patients’ with multiple myeloma, acute leukemias, lymphoproliferative disorders, myelofibrosis, marrow hypoplasia, osteitis fibrosa cystica and metastasis. BMB and BMA could detect tuberculous granulomas in 85.17% and 57.14% cases, respectively. However, parasitic infections (kala-azar, malaria) could be diagnosed exclusively in BMA. Conclusions: BMA and BMB are important, useful complementary diagnostic tools giving a higher diagnostic yield when used in conjunction.
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Systemic mastocytosis is a rare clonal disorder characterized by mast cell infiltration of one or more organs, with or without skin involvement. Leonine facies is a rare presentation and corresponds to the morphologic manifestation of diffuse dermal infiltration of the face as a result of long standing disease. Bone marrow aspiration and biopsy findings in a 60-year-old woman, who had extensive cutaneous infiltration due to systemic mastocytosis, resulting in 'leonine facies,' are described, and causes of leonine facies are discussed.
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Diagnostic Assessment of bone marrow aspirate particle smears, imprints and biopsy sections was done on 10 Non- Haematological disorders. Core needle biopsy of the bone marrow is a safe and useful procedure. It is a valuable diagnostic aid for measurement of marrow cellularity, metastatic tumours and fibrosis . Bilateral trephine biopsy was conducted wherever necessary. Touch imprints were useful for studying cell morphology, where aspiration yielded dry tap.All the three procedures of bone marrow aspiration, trephine biopsy and touch imprints were found to be complementary to each other and superiority of one method over the other depended on the specific disease process.
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Diagnostic Assessment of bone marrow aspirate particle smears, imprints and biopsy sections was done on 40 haematological disorders. Core needle biopsy of the bone marrow is a safe and useful procedure. It is a valuable diagnostic aid for measurement of marrow cellularity and fibrosis.Bilateral trephine biopsy was conducted wherever necessary.Bone marrow aspiration was the most effective method for studying morphological details and was able to diagnose most of the cases except the 2 cases of myelofibrosis which yielded dry tap for which trephine biopsy was diagnostic.Trephine biopsy was also found to be superior for staging of lymphomas and to study the ALIP in MDS.Touch imprints were useful for studying cell morphology, where aspiration yielded dry tap.All the three procedures of bone marrow aspiration, trephine biopsy and touch imprints were found to be complementary to each other and superiority of one method over the other depended on the specific disease process.
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PURPOSE: This study evaluated the influence of bone marrow cell collection techniques and donor site locations on the in-vitro growth of bone-forming cells. METHODS: Sixty six samples of bone marrow cell collections (BMCC) or bone marrow aspirates (BMA) from 15 patients were obtained. Thirty eight samples for culture were composed of 23 BMA from 7 tibial condyles and 16 ilia, with the other 15 BMCC from the contralateral ilia. The other 28 samples were used for the analysis of alkaline phosphatase activities. After counting total cell number, mesenchymal stem cells (MSC) obtained from samples were incubated for 14 days. Alkaline phosphatase staining was used to count the number of stained colonies to show osteogenic differentiation. RESULTS: The average MSC counts of BMA from tibial condyles and ilia were 1.42x10(6) and 7.35x10(6) respectively, with 4.80x10(6) from ilial BMCC (p=0.010). MSC cultures could not be produced from tibial condyles in all 7 samples. However, 9 of 15 BMCC samples and 9 of 16 ilial BMA samples were successfully cultured (p=0.018). The average of cell counts in the successful cultures was 7.92x10(6), whereas that in the failed cultures was 2.85x10(6) (p=0.000). Multiple regression analysis showed that colony count was associated with the patient's age and total cell numbers, but not with collection methods such as BMCC or BMA (p=0.000, R=0.648, beta; age=-0.405, cell number=0.356). The discriminating formula indicated that more than 5.25x10(6) cells were needed for successful culture. CONCLUSIONS: For successful cultures in vitro and for grafts, the total number of collected bone forming cells is more important than donor sites or collection methods. For young patients, grafting of bone-marrow-derived osteoprogenitor cells is promising.
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Humans , Alkaline Phosphatase , Bone Marrow , Bone Marrow Cells , Cell Count , Durapatite , Mesenchymal Stem Cells , Tissue Donors , TransplantsABSTRACT
This study was undertaken to look for evidence of acid fast bacilli (AFB) in bone marrow (BM) in patients of extrapulmonary tuberculosis. Fifty cases suspected of extrapulmonary tuberculosis underwent bone marrow aspiration from sternum/illiac crest and were put on a therapeutic trial of antituberculosis therapy. All cases taken in the study responded to the therapy. The pattern of involvement were – abdominal (20), CNS (19), pericardial involvement (5), cervical lymphadenopathy (2), PUO (2), spinal (1) and miliary (1). 52% cases showed evidence of AFB in BM (on Ziehl Neelsen’s (ZN) staining) whereas only 4% of cases showed evidence of AFB in any other body fluid (CSF/pericardium/peritonium). Besides this, cytomorphological changes of BM showed evidence of lymphocytosis (22%), increased plasma cells (80%) and prominence of macrophages (88%), thus signifying infective pathology with macrophage overactivity. So we conclude that bone marrow aspiration has a definite diagnostic value and may prove useful when other investigations are unrewarding.
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TuberculosisABSTRACT
BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) is one of the common hematologic disorders in children. Bone marrow aspiration(BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITP. MATERIALS AND METHODS: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of 50x109/L or lower was the cutoff level. RESULTS: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. CONCLUSION: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.