Importance of bone marrow examination in cases of pancytopenia: A morphological study.
Keywords:
Pancytopenia, Bone marrow examination, Megaloblastic anemia, Aplastic anemia, Acute leukemia.
Abstract
Background: Pancytopenia is a pathological manifestation resulting from various disease processes affecting the bone marrow. Therefore, bone marrow examination is an important diagnostic tool to evaluate the underlying causes of pancytopenia.Methods: Present study was done in 64 cases fulfilling the criteria of pancytopenia over a period of two years. Bone marrow examination including bone marrow aspiration and bone marrow biopsy (only in cases of dry tap on aspiration) was performed in all the cases and morphological study along with cytochemical staining was done. The findings were correlated with peripheral blood examination. Diagnostic value of bone marrow examination in cases of pancytopenia was established.Result: 61 out of 64 cases were successfully diagnosed with the morphological examination of bone marrow. The most common cause of pancytopenia in the present study was megaloblastic anemia (57.81%) followed by aplastic anemia (18.75%) and acute leukemia (9.37%). Other causes of pancytopenia were dimorphic anemia due to mixed deficiency, lymphoma, multiple myeloma, infectious disease and storage disease. The diagnostic value of bone marrow examination in cases of pancytopenia in the present study was 95.31%.Conclusion: Morphological examination of bone marrow is an extremely helpful and specific diagnostic tool in cases of pancytopenia. Bone marrow aspiration and biopsy complement each other but diagnosis can solely be made in most of the cases by examining only the bone marrow aspiration smears.References
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14. Alkhouri N, Ericson SG. Aplastic Anemia: Review of etiology and treatment. In Practice Stragies 1999;46:52
15. Chen SH, Hung CS, Yang CP, Lo FS, Hsu HH. Coexistence of megaloblastic anemia and iron deficiency anemia in a young woman with chronic lymphocytic thyroiditis. Int J Hematol 2006;84(3):238-41
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17. Medhi K, Kalita D, Chopra A, Anand M, Raina V, Kumar R. Multiple myeloma presenting with coexisting severe marrow hypoplasia. Indian Journal of Pathology and Microbiology 2008;51(4):543-545
18. Osama I, Haider ZB, Anwer F, Nisar H. Pattern of pancytopenia patients in a gerneral medical ward and a proposed diagnostic approach. J Ayub Med Coll Abbottabsd 2004;16:8-13
19. Imbert M, Scoazec JY, Mary JY, Jouzult H, Rochant H, Sultanc. Adult patients presenting with Pancytopenia. Hematol Pathol 1989;3(4):159-67
20. Parajuli S, Tuladhar A. Correlation of bone marrow aspiration and biopsy findings in diagnosing hematological disorders – a study of 89 cases. Journal of Pathology of Nepal (2014) Vol. 4, 534 – 538
21. Pathak R, Jha A, Sayami G. Evaluation of bone marrow in patients with pancytopenia. Journal of Pathology of Nepal (2012) Vol. 2, 265-271
2. Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow Examination in Cases of Pancytopenia. Indian Academy of Clinical Medicine 2001;2(1-2): 55-59
3. Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia. Indian J Pathol Microbiol 2002;45(3):375-9
4. Bhatnagar SK, Chandra J, Narayan S, Sharma S, Dutta AK. Pancytopenia in children: etiological profile. J Trop Pediatr 2005; 51(4):236-9
5. David G, Allen, Robert H, Ganaidzo, Innocent T, Levy, Lorraine M, Gwanzura, Christine F, Moyo, Alpha F, Mudenge, Boniface F, Kiire, Clement, Mukiibi, Joshua, Stabbler, Sally P, Lindenbaum, John. Pancytopenia in Zimbabwe. American Journal of the Medical Sciences 1999;317(1):22-32
6. Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. J Nepal Med Assoc 2008;47(169):12-7
7. Khanduri U, Sharma A. Causative and prevelance of megaloblastic anemia. Natl Med J India 2007;20(4):172-5
8. Bhatia P, Kulkarni JD, Pai SA. Vitamin B12 deficiency in India: Mean corpuscular volume is an unreliable screening parameter. The national medical journal of india 2012; 25(6): 336-38
9. Gupta V, Tripathi S, Singh TB, Tilak V, Bhatia BD. A study of bone marrow failure syndrome in children. Indian Journal of Medical Sciences 2008;62(1):13-18
10. Hayat AS, Khan AH, Baloch GH, Shaikh N. Pancytopenia; study for clinical features and etiological pattern of at tertiary care settings in Abbottabad. Professional Med J 2014;21(1): 060-065.
11. Memon S, Shaikh S, Nizamani MA. Etiological spectrum of pancytopenia based on bone marrow examination in children. J Coll Physicians Surg Pak 2008;18(3):163-7
12. Sohn SK, Suh JS, Lee J, Lee KB. Pancytopenic Prodrome(pre-ALL) of Acute Lymphoblastic Leukemia in Adults : Possible Pathogenesis. The Korean Journal of Internal Medicine 1998;13(1):64-67
13. Markovic SN, Phyliky RL, Li CY. Pancytopenia Due to Bone Marrow Necrosis in Acute Myelogenous Leukemia: Role of Reactive CD8 Cells. American Journal of Hematology 1998;59:74-78
14. Alkhouri N, Ericson SG. Aplastic Anemia: Review of etiology and treatment. In Practice Stragies 1999;46:52
15. Chen SH, Hung CS, Yang CP, Lo FS, Hsu HH. Coexistence of megaloblastic anemia and iron deficiency anemia in a young woman with chronic lymphocytic thyroiditis. Int J Hematol 2006;84(3):238-41
16. Bain BJ, Cavil IAJ. Hypochromic macrocytes: are they reticulocytes? J Clin Pathol 1993;46:963-64
17. Medhi K, Kalita D, Chopra A, Anand M, Raina V, Kumar R. Multiple myeloma presenting with coexisting severe marrow hypoplasia. Indian Journal of Pathology and Microbiology 2008;51(4):543-545
18. Osama I, Haider ZB, Anwer F, Nisar H. Pattern of pancytopenia patients in a gerneral medical ward and a proposed diagnostic approach. J Ayub Med Coll Abbottabsd 2004;16:8-13
19. Imbert M, Scoazec JY, Mary JY, Jouzult H, Rochant H, Sultanc. Adult patients presenting with Pancytopenia. Hematol Pathol 1989;3(4):159-67
20. Parajuli S, Tuladhar A. Correlation of bone marrow aspiration and biopsy findings in diagnosing hematological disorders – a study of 89 cases. Journal of Pathology of Nepal (2014) Vol. 4, 534 – 538
21. Pathak R, Jha A, Sayami G. Evaluation of bone marrow in patients with pancytopenia. Journal of Pathology of Nepal (2012) Vol. 2, 265-271
Published
2016-12-20
Section
Original Article
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