Place of Bone Marrow Biopsy as Compared to Bone Marrow Aspiration in Different Haematological Disorders.

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.

Púrpura trombocitopénica inmune en la infancia: 20 años de experiencia: 1985-2005 estado Cojedes-Venezuela / Autoimmune thrombocytopenic purpura in infancy: 20 years of experience: 1985-2005 Cojedes state-Venezuela

La púrpura trombocitopénica idiopática (PTI) es un síndrome caracterizado por diátesis hemorrágica consecuencia de la excesiva destrucción periférica de plaquetas, globalmente es considerada la trombocitopenia inmune más frecuente en niños. Describir el comportamiento clínico-epidemiológico de la PTI en el estado Cojedes, Venezuela. Se realizó un estudio descriptivo, prospectivo en niños con clínica de PTI que acudieron entre 1985 y 2005 al Hospital "Dr. Egor Nucete" de referencia del estado Cojedes, Venezuela. Las variables estudiadas fueron: época del año, procedencia, edad, género, antecedentes, manifestaciones clínicas, signos hematológicos, variedad clínica y tratamiento. Se realizó análisis estadístico descriptivo con distribuciones de frecuencia, porcentajes y gráficos de segmentos. 112 niños con PTI, incidencia acumulada promedio anual de 4,4/100.000 menores de 12 años; marzo, junio, julio y agosto mostraron el mayor número de casos y también los municipios San Carlos (30,36%), Falcón (18,75%) y Rómulo Gallegos (17,86%). Hubo mayor incidencia de PTI entre los 5 y 8 años (39%), sin diferencia entre géneros, pero con antecedentes de afección respiratoria superior en 82%; en lugar de predominó la forma aguda (91%), trombocitopenia menor de 50.000 plaquetas/mm3, sólo el 9% no recibió tratamiento terapéutico. La PTI es una patología de importante morbilidad en el estado Cojedes, de comportamiento epidemiológico similar al resto de América Latina y el mundo, su aparición está influenciada por factores ambientales, se resalta el predomino de la enfermedad entre los 2-8 años, sin distingo de género, con antecedentes infecciosos como factor de riesgo en la génesis del cuadro clínico y evolución satisfactoria aún sin tratamiento.

The immune thrombocytopenic purpura (ITP) it is a syndrome characterized by hemorrhagic, diathesis consequence of the excessive peripheric destruction of platelets, widely spread in the world and considered the most frequent thrombocytopenia in children. To description the clinic-epidemic behavior of the ITP in Cojedes state, Venezuela. It was done a descriptive prospective study with children with clinic of ITP who request medical assistance at the Hospital "Dr. Egor Nucete" of Cojedes state in a 20 years period. The variables studied were: time of the year, origin, age, gender, antecedents, clinical features, hematological signs, clinical variety and treatment. It was carried out statistical analysis. 112 children with ITP, cumulative annual average incidence of 4.4 for each 100.000 children less 12 years old; March, June, July and August showed most cases and also the municipalities of San Carlos (30.36%), Falcón (18.75%) and Rómulo Gallegos(17.86%). There was higher incidence of ITP among 5-8 years (39%), without difference among gender, but with antecedents of respiratory upper tract infection in 82% of the cases; The acute disease was predominant (91%), thrombocytopenia lower than 50.000 platelets/mm³, only 9% didn't receive treatment. The ITP is a disease of important morbility in the Cojedes state, with similar epidemic behavior than the rest of Latin America and the world, being its occurrence influenced by environmental factors, prevalence of the illness among the 2-8 years, without distinguish of gender, with infection antecedents as factor of risk in the genesis of the clinical features and satisfactory evolution without treatment.

Mecanismos celulares y bioquímicos involucrados en la fisiopatogenia de la púrpura trombocitopénica autoinmune / Cellular and biochemical mechanisms involved in physiopathogenesis of autoimmune thrombocytopenic purpura

Autoimmune thrombocytopenic purpura (ATP) is a bleeding disorder caused by excessive destruction of antibody-coated platelets. It is known that platelet destruction takes place in macrophages of reticulo-endothelial system, but immunological mechanisms involved in such destruction are unknown. The objective of this article is to review the literature concerning pathogenesis of ATP: to have controlled experimental conditions some animal laboratory models have been used. The (NZW X BXSB) F1 mice have been studied as autoimmune disease model and Harrington mouse as an immune purpura model. Studies in humans suggest that there are some differences in pathogenesis of acute or chronic ATP, particularly in reactive T cells. For example, in chronic form there are high levels of The (CD4+) activity concomitant with low levels of T suppressor (CD8+) activity, while in acute form there is no dominance of any particular T cell activity or CD4+ is even decreased. Mitogen lymphocyte proliferation is increased in chronic ATP but decreased in acute form.

Púrpura trombocitopénica idiopática / Idiopathic thrombocytopenic purpura

Se revisaron las historias clínicas de siete pacientes con púrpura trombocitopénica idiopática del servicio de Medicina Interna del Hospital Alberto Sabogal Sologuren del Callao entre enero de 1979 y enero de 1992, todos los casos fueron diagnosticados por un síndrome purpúrico asociado a trombocitopenia, anticuerpos antiplaquetarios positivos y médula ósea con megacariocitos en cantidad normal o aumentada. Se revisan los aspectos clínicos y de laboratorio así como la patogénesis de esta enfermedad, diagnóstico diferencial y tratamiento; aún en casos refractorios a corticoterapia, sin considerar en ningún caso la esplenectomía.