Bone Marrow Aspiration Cytology Studies In A Tertiary Hospital, Nigeria: A Serie Of 88 Cases
Keywords:
Bone Marrow Examination, Bone Marrow Aspiration, Cytology, Trephine Biopsy
Abstract
BACKGROUND: Bone marrow aspiration (BMA), an invasive test is crucial in evaluation of anaemias and other blood diseases, especially in situations where diagnosis remains cryptic after detailed clinical history, physical examination and peripheral blood analysis. BMA is performed by trained haematologists in the course of evaluating patients with primary or secondary haemopathies. However, there is sparse local data/report on its clinical utility. This study therefore assessed the common clinical indications, diagnostic findings and associated complications in our locality.METHODOLOGY: A prospective cohort study of 88 cases of BMA procedures among patients managed and co-managed by the adult haematology unit at the University of Benin Teaching Hospital (UBTH), Benin City was carried out. Relevant demographic, clinical data and intra-procedure details were obtained using a structured questionnaire within 24 hours of the procedure during the study period through case file review and patient interview. Intra-procedure intensity was graded in patients above 14 years using numeric pain scale of 0 to 10. All patients were followed up for a period of 1 to 2 weeks post-procedure.RESULT: The mean (SD) of the subject was 40 ± 24 years. Most (79.5%) of the BMA cytology were performed among adults (≥15 years of age), mostly on in-patient basis (86.4%). Posterior iliac crest was the most commonly used site (83%). Aspiration yield was adequate in 83% of cases. Mean intra-procedure pain score was 5.17 ± 2.01. Most common bone marrow diagnoses were combined (substrate) deficiency (26.1%), acute leukaemias (18.2%), pure megaloblastic anaemia (10.2%), malignant plasmacytosis (7.9%) and marrow carcinomatosis (7.9%). Pain was the most frequent complication, observed in 98.9% of cases.CONCLUSION: BMA cytology is a highly informative/diagnostic test procedure performed by haematologists in evaluating blood and blood related diseases in our environment. BMA is relatively safe although significant procedure related pain was frequently reported. Efforts should therefore be directed at better analgesia. Patients with unexplained cytopenias and other relevant indications should be referred for haematology consultation and possible BMA.References
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18. Bedu-addo G, Amoako YA, Bates I. The role of bone marrow aspirate and trephine samples in haematological diagnoses in patients referred to a teaching hospital in Ghana. Ghanian Medical journal 2013; 47(2): 74 – 78.
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20. Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol 2003; 121(6):
949 – 951.
2. Ryan DH, Felgar RE. Examination of the marrow. In: Lichtman MA, Kipps TJ, et al (eds). William’s haematology 7ed. New York, McGraw Hill 2006; 3: 21-31.
3. Gluckman E. Choice of the donor according to HLA typing and stem cell source. Apperley J, Carreras E, Gluckman E, Masszi T (eds). Haemotopoietic Stem cell transplantation. EBMT Handbook 6ed; 2012; 6: 90-107.
4. Bolan CD, Kurlander RJ, Schechter GP. Interpretation of standard hematologic tests. In: Rodgers GP, Young NS. The Bethesda handbook of clinical hematology. 3ed. 27: pp405 – 426.
5. Lee SH, Erber WN, Porwit A, et al: ICSH guidelines for the standardization of bone marrow specimens and reports. Int J Lab Hematol 2008; 30: 349 – 364.
6. Abla O, Friedman J, Doyle J. Performing bone marrow aspiration and biopsy in children: Recommended guidelines. Paediatr Child Health 2008; 13 (6): 499 – 501.
7. Halim NKD, Famodu AA, Wemanbu SNC. Textbook of Clinical Haematology and Immunology. Indications for bone marrow aspiration. 2nd Edition, Ambik Press; 2001: 10.
8. Trewhitt KG. Bone Marrow Aspiration and Biopsy: Collection and Interpretation. Continuing Education - Oncology nursing forum 2001; 28(9): 1409 – 1417.
9. 0 – 10 Numeric Pain Rating Scale. In: McCaffery M, Pasero C (eds). Pain: Clinical Manual. Mosby Inc. St. Louis, 1999, pg. 16.
10. Thieml H, Diem H, Haferlach T (eds). Procedures, Assays and Normal values. In: Color Atlas of hematology. Practical microscopic and clinical diagnosis. Thieme Stuttgart New York. 2ed, 2002; 2: 9 – 28.
11. Adewoyin AS, Nwogoh B. Peripheral Blood film: a review. Annals of Ibadan Postgraduate Medicine 2014; 12(2): 71 – 79
12. Jean-François L, Photis B. Pathophysiology and differential diagnosis of anaemia. In: Beaumont C, Beris P, Beuzard Y, Brugnara C (eds). ESH Handbook on Disorders of erythropoiesis, erythrocytes and iron metabolism. 2009, 4: pp108 – 141.
13. WHO/UNICEF/UNU. Iron deficiency anaemia: assessment, prevention and control. Geneva: World Health Organization 2001.
14. Erythropoiesis and general aspects of anaemia. In: AV Hoffbrand, PAH Moss, JE Pettit. Essential Haematology. 5th edition. 2006. 2: pp 12 - 27
15. Damulak OD, Damen JG. Diagnostic outcome of bone marrow aspiration in a new centre in Nigeria. Global Advanced Research Journal of Medicine and Medical Sciences 2012; 1(7): 166 – 171.
16. Egesie OJ, Joseph DE, Egesie UG, Ewuga OJ. Epidemiology of anaemia necessitating bone marrow aspiration cytology in Jos. Niger Med J 2009; 50: 61 – 63.
17. Pudasaini S, Prasad KBR, Rauniyar SK, Shrestha R, Gautam K, Pathak R, et al. Interpretation of bone marrow aspiration in hematological disorder. Journal of Pathology of Nepal 2012; 2: 309 – 312.
18. Bedu-addo G, Amoako YA, Bates I. The role of bone marrow aspirate and trephine samples in haematological diagnoses in patients referred to a teaching hospital in Ghana. Ghanian Medical journal 2013; 47(2): 74 – 78.
19. Bashawri LA. Bone marrow examination. Indications and diagnostic value. Saudi Medical Journal 2002; 23(2): 191 – 196.
20. Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol 2003; 121(6):
949 – 951.
Published
2015-10-26
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