The value of bone marrow examinations performed in the investigation of HIV infected patients with cytopenias

Abstract

Introduction Bone marrow examination (BME) is a reliable and effective tool in the diagnosis of many haematological and non‐haematological diseases and may be used to investigate unexplained cytopenia in human immunodeficiency virus (HIV) infected patients. The objective of this study was to determine the diagnoses made, diagnostic yield and unique diagnostic yield of BMEs performed to investigate cytopenias in HIV infected patients. Method A retrospective cross‐sectional descriptive study was performed involving all BMEs performed on HIV‐infected adult patients with the main indication of unexplained cytopenia over a period of 5 years and 4 months. Data was extracted from the National Health Laboratory Service's laboratory information system and clinicians' BME request forms. Results The study included 128 BMEs, performed on 124 patients. The diagnostic yield was 32% and the unique diagnostic yield was 30.5%. The most common diagnosis was pure red cell aplasia (10.9%), followed by immune thrombocytopenic purpura (ITP) (7%), iron deficiency anaemia (6.3%), malignancy (4.7%) and disseminated infection (3.9%). Conclusion BME is a useful investigation for unexplained cytopenia in HIV‐infected patients. Less invasive investigations to exclude haematinic deficiencies, haemolysis and sepsis are recommended on an individualised basis prior to BME. In HIV‐infected patients with therapy refractory ITP or ITP with atypical clinicopathological findings, BME is strongly recommended. As Mycobacterial and other infections are common in this group of patients, staining and culture of specimens are advised if BME is undertaken.

Hematological Complications of Human Immunodeficiency Virus (HIV) Infection: An Update From an HIV-Endemic Setting

“…BM infiltration, by opportunistic infection and/or malignancy, may displace normal hematopoiesis, leading to anemia and other cytopenias ( Figure 1 ). The commonest coinfection in the BM in PWH is Mycobacterium tuberculosis (TB), with Mycobacterium avium complex and fungal infection including Cryptococcus neoformans and Histoplasma capsulatum occurring more rarely [ 27 , 28 ]. These infections typically cause reactive granuloma formation.…”