RESUMO
OBJECTIVE: To determine the association of peripheral blood counts (cytopenia and normal counts) with bone marrow findings in patients with malignant neoplasms. STUDY DESIGN: Descriptive study. Place and Duration of the Study: King Edward Medical University from 2017 to 2019. METHODOLOGY: Patients having malignant diseases, of both gender and all ages, were included. Clinical data and results of bilateral bone marrow aspiration and biopsy were noted. Results were categorised as groups with bone marrow infiltration, normal morphology with normal cellularity and normal morphology with decreased cellularity. Results were analysed using SPSS V21 applying Chi-square test, keeping the confidence interval 95% and p-value of <0.05 as significant. RESULTS: A total of 157 patients were included (107 men, 50 women). The main categories of neoplasm included non-Hodgkin's lymphoma [93 (59.2%)] Hodgkin's lymphoma [31 (19.7%)], and solid organ malignancy [33 (21.0%]. Bone marrow infiltration was seen in 50 (31.8%) patients, normal morphology with decreased cellularity in 51 (32.5%) and normal morphology with normal cellularity in 56 (35.7%) patients. Cytopenias were seen in 88 (56.1%) patients (out of these 28 (31.8%) had bone marrow infiltrarion, 32 (36.4%) had decreased cellularity and 28 (31.8%) with normal cellularity). In 69 (43.9%) patients with normal CBC, 22 (31.9%) had infiltration, 19 (27.5%) had decreased cellularity and 28 (40.6%) had normal cellularity. No association of cytopenia with bone marrow results was obtained (p = 0.086). CONCLUSION: Bone marrow infiltration and hypocellularity are not reflected by peripheral blood counts. Therefore, bone marrow biopsy remains decisive in patients with malignant neoplasm for disease staging and selection of treatment options. Key Words: Peripheral blood counts, Bone marrow infiltration, malignant neoplasms, bone marrow hypocellularity.
Assuntos
Anemia , Doença de Hodgkin , Linfoma não Hodgkin , Biópsia , Medula Óssea , Feminino , Humanos , MasculinoRESUMO
ABSTRACT Objective: To determine immature platelet fraction (IPF) in patients with thrombocytopenia and correlation with their bone marrow findings and to determine its predictive value in differentiating peripheral (hyper destructive) thrombocytopenia from central (hypo-productive) thrombocytopenia. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: King Edward Medical University (KEMU) and Doctors Hospital Lahore, from December 2018 to February 2019. METHODOLOGY: Patients of both genders and all age groups with thrombocytopenia presenting for bone marrow biopsy were included in the study. Clinical data, complete blood count (CBC) sample in EDTA, bone marrow aspirate and trephine biopsy were obtained. Slides were prepared and reviewed. CBC sample was analysed for counts and IPF in Doctors Hospital Laboratory within 4 hours of collection. RESULTS: According to bone marrow findings, patients were grouped under two categories; Group 1 with central (hypo-productive group) thrombocytopenia and Group 2 with peripheral (hyper-destructive group). Group1 (n=44) showed median interquartile range (IQR) IPF 8.2 (4.6-16.7), which was significantly lower (p <0.001) than that of Group 2 (n=14) in which Median IQR IPF was 25.5 (15.2-39.3). A significant moderate degree negative (inverse) correlation was observed between platelet counts and IPF in thrombocytopenic patients in both groups by Pearson correlation. It was statistically significant at p <0 .001 level. IPF in hyper-destructive group has 100% predictive value compared to 31% in hypo-productive group. CONCLUSION: IPF is a useful parameter and can reliably identify patients having thrombocytopenia due to peripheral destruction. In other cases, IPF should be used in conjunction with other investigations like bone marrow biopsy etc. Key Words: Immature platelet fraction, Complete blood count, Central thrombocytopenia, Peripheral thrombocytopenia, Bone marrow failure, Peripheral destruction.
