The diagnostic utility of bone marrow examination in an infectious disease ward

Abstract

BackgroundPatients with advanced human immunodeficiency virus often present with unexplained fevers or cytopenias. Bone marrow aspirate and trephine examinations are an invasive means to aid diagnoses in patients who present with diagnostic dilemmas.ObjectivesA retrospective record review to assess the diagnostic utility of bone marrow examinations in a South African Infectious Diseases ward.MethodsThe records of patients who had undergone a bone marrow examination in the Infectious Disease ward at the Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, between 01 January 2012 and 31 December 2014 were reviewed. A unique diagnosis was considered to be any diagnosis made on bone marrow examination alone, or a diagnosis made more timeously on bone marrow examination than with alternative investigations.ResultsOf 327 patients who underwent bone marrow examination, 80 unique diagnoses were obtained in 77 cases (23.5%). The unique diagnoses included the presence of granuloma (n = 49), Mycobacterium tuberculosis (n = 17), Mycobacterium avium complex (n = 3), haematological malignancy (n = 4) and pure red cell aplasia (n = 5). A white cell count ≤ 4 × 109/L predicted a unique outcome (p < 0.01). A white cell count ≤ 4 × 109/L and CD4 cell count ≤ 50 cells/mm3 predicted mycobacterial infection of the bone marrow.ConclusionsThe findings of a unique diagnosis in 23.5% of bone marrow examinations performed suggests that this remains a useful investigative modality in patients in whom less invasive investigations have not yielded a diagnosis.

Indications and diagnostic value of bone marrow examination in HIV-positive individuals: A 3-year review at Tygerberg Hospital

“…Other studies focussed on the diagnostic yield of bone marrow examination in HIV-positive patients with fever and/or cytopenia or HIV-positive patients from a selected ward with defined admission criteria. 4 , 10 Studying the indications and the diagnostic yield of bone marrow examination in unselected HIV-positive patients provides an additional advantage to previous studies by examining the diagnostic utility of bone marrow examination in afebrile HIV-positive patients. This difference in the study population may explain the major differences in our results compared with other South African studies.…”

“…The indications for bone marrow examination were widely variable in this study, unlike other South African studies. 4 , 10 The most common indications were bicytopenia or pancytopenia. The second most common indication was assessment of known cases of acute leukaemia.…”

“…Several studies aimed at determining the diagnostic yield of bone marrow examination found it to range from 27% to 47%. 3 , 8 , 9 , 10 , 11 , 12 The diagnostic utility of bone marrow examination has been recently reviewed in the South African setting. Diagnostic utility in this context, is measured using the diagnostic yield and is defined as the number of diagnoses obtained from such a procedure.…”

“…Diagnostic utility in this context, is measured using the diagnostic yield and is defined as the number of diagnoses obtained from such a procedure. 10 Bharuthram et al estimated the diagnostic yield at 48% with 33% achieving a unique diagnosis. However, this study cannot be generalised to other units and hospitals as the study population only included patients who were admitted to the infectious disease (ID) unit.…”

“…However, this study cannot be generalised to other units and hospitals as the study population only included patients who were admitted to the infectious disease (ID) unit. 10 The diagnostic utility of this invasive procedure is still unclear, particularly when patients are afebrile and without clinical suspicion of haematological malignancies.…”