Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 5  |  Issue : 2  |  Page : 118-121  

Spectrum of hematological disorders observed in one-hundred and ten consecutive bone marrow aspirations and biopsies


Department of Pathology, Mamata Medical College, Khammam, A.P, India

Date of Web Publication10-Nov-2012

Correspondence Address:
Srikanth M Shastry
Department of Pathology, Mamata Medical College, Khammam, A.P
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 

Introduction: The study was done to know the spectrum of hematological disorders. Materials and Methods: This was a retrospective and prospective study of bone marrow aspiration (BMA) and biopsies done on patients who were referred for bone marrow examination. Cases were analyzed in detail regarding clinical examination and other investigations. Results: BMA from 110 patients were analyzed. Nutritional anemia contributed highest number of cases among the nonhematological group. Out of nutritional anemia megaloblastic anemia was the most common disorder. Acute myeloid leukemia was the commonest malignant hematological disorder in the present study. Among 110 cases 56 cases were male and 54 were female patients with highest number of cases in the age group of 21-30 years. Conclusion : Although bone marrow examination is an invasive procedure this is well tolerated by patients. The examination helps in many cases to arrive at a final diagnosis within a short span of time.

Keywords: Bone marrow, malignant hematological disorders, non malignant


How to cite this article:
Shastry SM, Kolte SS. Spectrum of hematological disorders observed in one-hundred and ten consecutive bone marrow aspirations and biopsies. Med J DY Patil Univ 2012;5:118-21

How to cite this URL:
Shastry SM, Kolte SS. Spectrum of hematological disorders observed in one-hundred and ten consecutive bone marrow aspirations and biopsies. Med J DY Patil Univ [serial online] 2012 [cited 2020 Aug 13];5:118-21. Available from: http://www.mjdrdypu.org/text.asp?2012/5/2/118/103334


  Introduction Top


Hematological disorders are quite frequent in population. Most of the times the diagnosis can be arrived by detail clinical examination and few simple investigations. However without bone marrow examination the diagnosis is usually not confirmed. Bone marrow aspiration (BMA) examination is one of the most frequent and relatively safe invasive procedure. Though an invasive procedure it can be easily performed even in the presence of thrombocytopenia with little or no risk of bleeding. [1] Biopsy of bone marrow is an adjunct to the study of hematological disorders which are [2] quite frequent in all age groups. They may range from very common condition like deficiency disorder to relatively rare multiple myeloma. The spectrum of hematological disorders is relatively different in the developing world than the developed countries. [3]

Commonly it is done for the evaluation of unexplained cytopenias and malignant conditions like leukemia. Bone marrow examination is also at times done for the diagnosis or staging of a neoplasm and storage disorders. Trephine biopsy is usually performed when there is hypoplasia or aplasia suspected on aspiration.

The present study was undertaken with the view to study the etiological spectrum of disorder as diagnosed on bone marrow examination and to know the age incidence and male to female ratio.


  Materials and Methods Top


A retrospective and prospective study of patients who underwent bone marrow aspiration/biopsies was done during the period of one and a half year. Bone marrow was aspirated from sternum or posterior iliac spine after giving local anesthesia.


  Results Top


Findings from a total 110 patients who underwent BMA/Trephine biopsy procedure were tabulated. [Table 1] and [Table 2] show the age and gender distributions of these patients, respectively. [Table 3] shows the bone marrow examination findings of study population. In the present study nutritional anemia contributed highest number of cases amongst the nonhematological group. Out of nutritional anemia; megaloblastic anemia was the most common disorder [Figure 1] a and b. Acute myeloid leukemia (AML) was the commonest malignant hematological disorder in the present study [Figure 2] a and b. Other malignant disorders include chronic myeloid leukemia, metastatic deposits primary from the prostatic carcinoma [Figure 3] a and b and multiple myeloma [Figure 4] a and b. Among 110 cases, 56 cases were male and 54 were female patients with highest number of cases in the age group of 21-30 years.
Figure 1: Bone marrow aspiration smears showing many early and intermediate normoblasts having megaloblastoid changes with royal blue cytoplasm and sieve-like chromatin (Figure a, Giemsa ×10: Figure b, Leishman ×40) - Megaloblastic anemia

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Figure 2: Peripheral smear showing Myeloblast along with  Auer rods More Details (Figure a, Leishman ×40). Bone marrow aspiration smears showing Myeloblasts and blast-like cells upto 60% arranged in sheets having moderate amount of cytoplasm with 2-3 prominent nucleoli – AML. (Figure b, Leishman ×40)

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Figure 3: Bone marrow aspiration smears showing tumor cells arranged in clusters and in groups (Figure a, Leishman ×10). Tumor cells which are hyperchromatic, moderate degree of pleomorphism with nucleoli (Figure b, Leishman ×40)- Metastatic deposits

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Figure 4: Bone marrow aspiration smears showing many plasma cells and binucleate plasma cells more than 70% (Figure a, Leishman ×40). Bone marrow biopsy showing plasma cells more than 70% (Figure b, H and E ×40) – Multiple Myeloma

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Table 1: Showing age distribution

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Table 2: Showing sex distribution

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Table 3: Shows findings of bone marrow examination

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  Discussion Top


The spectrum of hematological disorders both in children and adults is very wide. Bone marrow examination is a useful test in reaching the final diagnosis. Bone marrow trephine biopsy is an important adjunct to aspiration in arriving at an etiological diagnosis. BMA is one of the most common and safe procedure done routinely in medical practice. Rarely infection, excessive bleeding or embolism has been reported after bone marrow biopsy. [4]

In the present study we analyzed the data obtained from these patients to know the relative frequency of different hematological disorders.

In the present study nutritional anemia was the commonest disorder identified similar to a study by Rahim et al. [1] In other similar studies its frequency ranges from as low as 24% to as high as 68%. [5],[6] Folate deficiency is more common in children, while B12 deficiency is more common in adults. [6]

The commonest hematological malignancy noted was AML similar to other studies such as Rahim et al. [1]

Lysosomal storage disorder is often diagnosed initially by bone marrow examination. [7]

One case of lysosomal storage disorder was diagnosed on bone marrow examination. We found that bone marrow examination is helpful in making primary diagnosis of storage disease either primary or secondary, in majority of pediatric cases.

Many studies have concluded that BMA will yield diagnostic result in majority of cases. [4],[5] In our study also we could diagnose many cases on BMA alone.

Although BMA and biopsy is an uncomfortable procedure for the patient and should be performed only when there is a clear clinical indication, [8] yet it is a useful technique not only in the diagnosis of different blood disorders but also for various systemic illnesses including pyrexia of unknown origin.

 
  References Top

1.Rahim F, Ahmad I, Islam S, Hussain M, Khattak TA, Bano Q. Spectrum of hematological disorders in children observed in 424 consecutive bone marrow aspirations/biopsies. Pak J Med Sci 2005;21:433-6.  Back to cited text no. 1
    
2.Bates I. Dacie and Lewis Practical Haematology. In: Mitchell Lewis, Barbara Bain, Imelda Bates, editors. Bone marrow biopsy. 10 th ed. Philadelphia: Churchill Livingstone; 2011. p. 115-30.  Back to cited text no. 2
    
3.Young NS, Abkowitz JL, Luzzatto L. New Insights into the Pathophysiology of Acquired Cytopenias. Hematology Am Soc Hematol Educ Program 2000:18-38.  Back to cited text no. 3
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4.Onal IK, Sümer H, Tufan A, ShorbagiA. Bone marrow embolismafter marrow aspiration and biopsy. Am J Hematol 2005;78:158.  Back to cited text no. 4
    
5.Mussarat N, Raziq F. The incidence of underlying pathology in pancytopenia. An experience of 89 cases. J Postgr Med Inst 2004;18:76-9.  Back to cited text no. 5
    
6.Ng SC, Kuperan P, Chan KS, Bosco J, Chan GL. Megaloblasticanaemia--a review from University Hospital, Kuala Lumpur. Ann Acad Med Singapore 1988;17:261-6.  Back to cited text no. 6
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7.Chang KL, Gaal KK, Huang Q, Weiss LM. Histiocytic lesions involving the bone marrow. Semin Diagn Pathol 2003;20:226- 36.  Back to cited text no. 7
[PUBMED]    
8.Bain BJ. Bone marrow trephine biopsy. J Clin Pathol 2001;54:737-42.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Materials and Me...
Results
Discussion
References
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