Study of diagnostic accuracy of bone marrow aspiration and bone marrow biopsy in pancytopenia patients

Abstract

Background:Pancytopenia is defined by reduction of all three formed elements of blood below the normal reference. It can be a manifestation of a wide variety of disorders, yet there is a few reported studies of the frequencies of various etiologies, and these frequencies exhibit substantial geographic variation. Bone marrow aspiration and biopsy evaluation along with good clinical correlation is of utmost importance to evaluate the causes of pancytopenia.Aim of study: The present study was a prospective clinicohaematological study undertaken to analyze the various causes of pancytopenia by evaluating bone marrow aspiration and biopsy and correlating with clinical findings, complete blood counts and peripheral blood picture. The present study was under taken to evaluate the accuracy of the bone marrow aspiration and biopsy in the diagnosis of hematological disorders presenting with pancytopenia. Methods: This was prospective study Conducted in Tishreen academic hospitals in Lattakia city, Syria, over a period of one year (May 2016-May 2017).A total of 70 patients (32 female, 38 male) with the diagnosis of pancytopenia were enrolled in the study, written consent was obtained for the patients to participate in the study. A detailed medical history, full physical examination, complete blood count with peripheral film, erythrocyte sedimentation rate   , liver function tests and serology for viral hepatitis, ultrasonography of abdomen.  Bone marrow aspiration and   bone marrow biopsy have been done for all patients. Perl’s stain, immune-histochemistry and reticulin were done wherever necessary. Results:The majority of cases were encountered in the age group of  more than sixty years old .Infiltration disorders were the commonest cause ( 35.71%) followed by viral infections  (25.71%) , megaloblastic anemia (10%) ,  aplastic anemia (10%) , myelodysplasia (7,14%), myelofibrosis( 7,14%) and  leshmaniosis ( 4,28%) . bone marrow biopsy was superior in the diagnosis of infiltrative lesions (100% versus 33-50%), in aplastic anemia (100% versus 0%) myelofibrosis (100% versus 0%) and myelodysplasia (100% versus 20%), while bone marrow aspiration was superior in the diagnosis of infectious lesions such as leishmaniasis (66.66% versus 33.33%).  Bone marrow aspiration was diagnostic of in 100% of cases in megaloblastic anemia the bone marrow aspiration alone was conclusive in only 20 patients( 25.71%), while the  bone marrow biopsy procedure alone was conclusive in 50 patients ( 71.42%), and when the aspiration and biopsy were performed together, the diagnostic rate increased to 84.2%  (59/70)                   patients. Conclusion: This study concluded that most common cause of pancytopenia is infiltration disorders followed by infections. The advantages of bone marrow aspiration and biopsy differ; both are complimentary to each other and should be performed simultaneously for a complete bone marrow work up and evaluation. Elaborate hematological investigations and bone marrow examination, both, in correlation with clinical findings are vital for the diagnosis of pancytopenia.