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

Clinicohaematological spectrum of pancytopenia in a tertiary care hospital

To determine the frequency, clinical presentation and underlying causes of pancytopenia inpatients presenting to a tertiary care hospital in Peshawar. This cross-sectional, observational study was conducted at Department of Pathology, Lady Reading Hospital Peshawar from January to December 2011. Patients of all ages having pancytopenia on blood film examination [TLC < 4000/ul, Hb < 10 gm/dl and Platelets < 150000/ul] were included in the study. Already diagnosed patients of Aplastic Anemia, Acute Leukemia receiving treatment and those not willing for bone marrow examination were excluded from the study. History, General Physical and systemic examination were recorded at presentation. The peripheral blood counts were performed with sysmex - automated hematology analyzer. Bone marrow aspiration and trephine biopsy were performed according to the standard protocol and examined microscopically to find the underlying cause of pancytopenia. Other relevant investigations were also done. During the study period, we received 600 patients for bone marrow examination from various units. Out of these, 160 [26.7%] patients had pancytopenia. Common clinical presentations were Pallor[95%, n=150], followed by generalized weakness [75%, n=120], fever [52%, n=83], bleeding manifestation[37.5%, n=60], gastrointestinal symptoms [32.5%, n=52] and splenomegaly [23.5%, n=38]. The common causes of pancytopenia were aplastic anemia [37.5%, n=60] followed by magaloblastic anemia [13.75%,n=22], Acute Leukemia [13.75%, n=22] and hypersplenism [10%, n=16]. Pancytopenia is a common occurrence. Aplastic Anemia and Magaloblastic Anemia are the commonest causes of Pancytopenia followed by Acute Leukemia. Common clinical presentations were Pallor, fever, weakness, bleeding manifestation and Splenomegaly