Utility of Bone Marrow Examination in Pediatric Age Group: Experience of a Tertiary Healthcare Centre in India

Abstract

Bone marrow is involved in various haematological and non-haematological conditions in the paediatric age group. To understand and analyse the underlying etiology, bone marrow examination, including both bone marrow aspiration and trephine biopsy, forms an important diagnostic tool. It helps to differentiate proliferative disorders of the myeloid and lymphoid series, find out their prognosis based on severity, and assess their status before therapy is started. It also aids in staging and in the detection of infiltration of the marrow by foreign cells. The spectrum of disorders affecting the marrow in children ranges from common disorders like nutritional deficiency anaemia to serious conditions like leukaemia. Their line of management, severity, and prognosis differ from the bone marrow lesions found in adults. The present study was done to demonstrate the utility of bone marrow examination in the paediatric age group, to demonstrate its contribution to the final diagnosis of the patient, and to list and study the various lesions encountered in this age group in a tertiary care teaching hospital and for better understanding of clinicopathological features and microscopy, suggesting variation with or convergence with literature. Material and methodsThis was an observational study with a combination of retrospective and prospective studies, carried out over a period of six years, from January 2014 to December 2019. All bone marrow aspiration and biopsy samples received in the surgical pathology department of our tertiary healthcare centre during the study period of patients between zero and 18 years of age were included. Samples obtained at autopsy and samples where the tissue was diluted or the marrow was inadequate were excluded from the study. Detailed histomorphology was studied in all cases, and the data obtained was recorded in an excel sheet. The descriptive statistics were expressed in terms of numbers and percentages. The study was ethically approved by the Ethics and Research Committee of our hospital before the commencement of the study. ResultsThe maximum number of marrows were performed in the age group of 12-18 years, followed by six to 12 years. The most common indication for performing bone marrow examination was 'evaluation of cytopenias', followed by 'suspected/to rule out haematological malignancy'. A male predominance was found. Overall and amongst neoplastic lesions, acute leukaemia was the commonest diagnosis in the bone marrow. Infections were the second most common lesion overall and the commonest non-neoplastic lesion encountered. ConclusionThe spectrum of lesions requiring bone marrow examination in the paediatric age group is of varied etiologies. Bone marrow examination in children is useful in understanding the pathogenesis, establishing a tissue diagnosis, ruling out haematological malignancies and other causes of cytopenias, planning further lines of investigations and management, and knowing the response to therapy and prognosis.