Diagnostic role of bone marrow aspiration and trephine biopsy in haematological practice

To determine the usefulness of bone marrow aspiration and trephine biopsy in evaluation of the bone marrow in routine haematological practice. This study included 443 cases of bone marrow examination, referred to Pathology Department, Lady Reading Hospital Peshawar during the period extending from January 2012 till July 2013. All the bone marrow smears and bone biopsy sections were examined in detail. The diagnosis and findings on aspirate and biopsy were evaluated and compared with each other. In 73.8% of the cases the bone marrow aspiration and trephine biopsy showed same diagnosis i.e., bone marrow aspiration alone was sufficient for diagnosis in these cases. In the remaining 116 [26.2%] cases trephine biopsy sections or touch imprints were found to be necessary in for making final diagnosis. These cases were those of the hypoplastic / aplastic marrows, Myelofibrosis, lymphomatous infiltration and chronic granulomatous inflammation. The study results suggest that both the aspirate and trephine biopsy complement each other. Nutritional anaemias, Haematological Malignanciesand Immune Thrombocytopenia can be readily diagnosed by bone marrow aspiration alone. Trephine biopsy is necessary for diagnosing Granulomatous Inflammation and Hypoplastic/Aplastic Anaemia. Also trephinebiopsy is required to diagnose Myelofibrosis and Lymphomatous infiltration

Bone marrow examination in cases of pancytopenia.

This study was carried to identify the causes of pancytopenia and to find out the bone marrow morphology 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 fulfilling the criteria of pancytopenia were examined. The data obtained were analyzed using measures of central tendency. One hundred and forty eight cases underwent bone marrow aspiration and it constituted 15.74% of total cases. Mean age was 30 years (range, 1-79 years). 42 cases were children (28.37%). Male: female ratio was 1.5:1. The commonest cause was hypoplastic bone marrow seen in 43 cases (29%) followed by 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 children and chronic pure red cell aplasia and leishmaniasis in adults. Acute leukemia was the commonest hematological malignancy. In children, commonest finding was hypoplastic bone marrow (38.1%) while in adults megaloblastic anemia (30.18%) was commonest finding followed by hypoplastic anemia (25.47%). In present study bone marrow examination was able to establish diagnosis in 77% of cases. Hypoplastic marrow was the commonest diagnosis, followed by megaloblastic anemia, and hematological malignancies.

Bone marrow iron in nutritional anaemias.

Bone marrow smears of 168 patients with nutritional anaemias attending the Dr. J.C. Patel, Department of Hematology, K.E.M. Hospital were stained by Prussian blue method for iron (haemosiderin). Iron in the bone marrow was classified as absent, decreased, normal or increased. Amongst 93 cases with transferrin saturation (TS) of less than 16% and normoblastic erythropoiesis, bone marrow iron was absent in 48 (51.6%) and decreased in 45 (48.4%). In 50 cases with TS of less than 16% and marrow showing megaloblasts and/or giant myelocytes and metamyelocytes, bone marrow iron was absent in 15 (30%), decreased in 22 (44%), normal in 7 (14%) and increased in 6 (12%). In 25 cases with TS over 16% and megaloblastic erythropoiesis, bone marrow iron was absent in 4 (16%), decreased in 1 (4%), normal in 7 (28%) and increased in 13 (52%). In 150 (89.3%) patients out of 168, bone marrow iron and TS gave concordant results whereas in 18 (10.7%), the results were discordant; former was encountered in cases of uncomplicated iron deficiency while latter was found with megaloblastic morphology of the marrow. It is concluded that there is a good correlation between TS and bone marrow iron and hence, either of the criteria can be used for the diagnosis of iron deficiency especially when it is not complicated by megaloblastosis.

Anemia megaloblástica en pacientes mayores de 14 años en un período de 10 años (enero de 1977 a diciembre de 1986) en el Hospital General Cayetano Heredia / Megaloblastic anemia in patients older than 14 years in a period of 10 years (January 1977 - December 1986) in the Hospital General Cayetano Heredia

Revisión de los casos de anemia megaloblástica encontrados en el Hospital Cayetano Heredia en pacientes mayores de 14 años, entre enero 1977 y diciembre 1986. Se halló 41 pacientes 12 por deficiencia de ácido fólico, 18 por deficiencia de vitamina B12 y 11 de causa no determinable; hubo predominio del sexo masculino en el de a. fólico; siendo pacientes más jóvenes los correspondientes al grupo de ácido fólico en comparación al de vitamina B12 en que la mediana estaba en 60 años. Un 68 por ciento presentó disnea al momento de admisión, 34 por ciento edema (hipoalbuminemia), 44 por ciento tenían algún tipo de infección, especialmente los debidos a deficiencia de a.fólico (urinaria y pulmonar más frecuentemente); igualmente en este grupo un 75 por ciento tenían antecedente de embarazo. El hematocrito promedio fue de 18.91, teniendo anemia severa el 61 por ciento y pancitopenia el 32 por ciento; en cuanto a respuesta terapéutica, al día séptimo de iniciado, el índice de producción medular subió de 0.32 a 3.13 y el hematocrito de 18.91 a 24.39 en promedio, normalizándose el valor al día 60. La mortalidad fue del 7 por ciento, debido a sepsis