Published: 2017-02-20

Bone marrow aspiration cytology in the diagnosis of hematologic and non-hematologic diseases in a multi-specialty hospital in Nepal

Sabin Ranabhat, Sushna Maharjan, Mamata Tiwari, Anita Bhandari, Bidur Prasad Osti


Background: Peripheral blood smear examination and other routine laboratory assays are not always sufficient to diagnose various diseases which affect the blood and bone marrow. A bone marrow aspirate examination is essential in most of the cases.

Methods: This work was a hospital-based cross sectional analytical observational study carried out in the department of pathology at the Chitwan Medical College, Teaching Hospital, Nepal, over a period of 3 years from January, 2013 to December 2015. Bone marrow was aspirated from posterior superior iliac crest under local anesthesia; sternum was the alternative site in obese patients. Univariate analysis was performed for each variable using frequency distribution and means with the help of Statistical Package for Social Sciences 20.0 (SPSS 20.0) software.

Results: One hundred and fifty-nine patients were included in the study. Eight cases of 'dry tap' were excluded, for whom bone marrow biopsy was advised. Anemia was the largest group followed by malignancy, infection and miscellaneous diseases. Among anemia, megaloblastic anemia was the most common, followed by aplastic anemia, dyserythropoietic anemia and myelopthisic anemia. The category 'malignancy' consisted of leukemia, multiple myeloma and myelodysplastic syndrome. Regarding individual diseases, megaloblastic anemia was the most common haematological disorder followed by immune thrombocytopenic purpura, leukemia and aplastic anemia.

Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many haematological and non-hematologic diseases that can be confirmed by more advanced investigations, if needed: serological, biochemical or molecular. However, bone marrow sample cannot be obtained (dry tap) in a proportion of cases. In such cases, a bone marrow biopsy needs to be performed.


Bone marrow aspiration cytology, Nepal, Spectrum of diseases

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Malempati S, Joshi S, Lai S, Braner D, Tegtmeyer K. Bone marrow aspiration and biopsy. N Engl J Med. 2009;361:e28.

Riley RS, Ben-Ezra JM, Pavot DR, Forysthe R, Massey D, Wright L et al. An illustrated guide to performing the bone marrow aspiration and biopsy. Available at http:// pdf/ Bone%2 0marrow%20aspiration% 20technique.pdf.

Plat A, Eckman JR. Diagnosing Anemia. Available at pa/ documents/ AnemiaCR2006.pdf. Accessed 9 December 2016.

Pujara KM, Bhalara RV, Dhruva GA. A study of bone marrow iron storage in hematological disorder. Int J Health Allied Sci. 2014;3:221-4.

Means RT, Glader B. Anemia: General Conditions. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means RT eds. Wintrobe's Clinical Hematology. 12th ed. Philadelphia, Pa: Lippincott Williams and Wilkins, a Wolters Kluwer business. 2009;779-809.

Attar EC. Leukemia Review: Types, Diagnostics, Treatments. Available at Public/ meetings/ presentations/ 2010/ summer_group/ cra_cont_ed/01_Attar_062010.pdf. Accessed 9 December 2016.

Pathak R, Jha A, Sayami G. Evaluation of bone marrow in patients with pancytopenia. J Patho Nepal. 2012;2:265-71.

Rodgers GM, Lehman CM. Diagnostic approach to bleeding disorders. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means RT eds. Wintrobe's Clinical Hematology. 12th ed. Philadelphia, Pa: Lippincott Williams and Wilkins, a Wolters Kluwer business. 2009;1283.

Parajuli S, Tuladhar A. Correlation of bone marrow aspiration and biopsy findings in diagnosing hematological disorders – a study of 89 cases. Journal of Pathology of Nepal. 2014;4:534-38.

Momani A, Khasawneh R, Abed R. Spectrum of Bone Marrow aspiration test results at Prince Rashid Hospital/Jordan; A 3-Year Experience. Int J Biol Med Res. 2012;3(2):1648-50.

Atla BL, Anem V, Dasari A. Prospective study of bone marrow in haematological disorders. Int J Res Med Sci. 2015;3(8):1917-21.

Adewoyin AS, Ezire ES, Adeyemi O, Idubor NT, Edewor-Okiyo DO. Bone marrow aspiration cytology studies in a tertiary hospital, Nigeria: a series of 88 cases. APALM. 2015;02(04):2015.

Chand N, Singla S, Sangwan K, Bansal H, Bajwa D, Sharma A, et al. Diagnosis of hematological and non-hematological disorders using bone marrow aspiration and trephine biopsy (a correlating study). Res J Pharm, Bio Che Sci. 2015;6(4):125.

Pudasaini S, Prasad KBR, Rauniyar SK, Shrestha R, Gautam K, Pathak R, et al. Interpretation of bone marrow aspiration in hematological disorder. J Patho Nepal. 2012;2:309-12.

Thiyagarajan P, Suresh TN, Anjanappa R, Kumar ML. Bone-marrow spectrum in a tertiary care hospital: Clinical indications, peripheral smear correlation and diagnostic value. Med J DY Patil Univ. 2015;8:490-4.

Andrès E. What impact for sex difference on immune thrombocytopenic purpura? Women Health Open J. 2016;2(1):e1-e3

Kibria SG, Islam MDU, Chowdhury ASMJ. Prevalence of hematological disorder: a bone marrow study of 177 cases in a private hospital at Faridpur. Faridpur Med Coll J. 2010;5:11-3.

Ahmad SQ, Khan OU, Zafar N. Utility of bone marrow examination in a secondary care hospital. JRMC. 2011;15:40-1.

Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone marrow examination in cases of pancytopenia. JIACM. 2001;2:55-9.

Incidence of aplastic anemia: the relevance of diagnostic criteria. By the International Agranulocytosis and Aplastic Anemia Study. Blood 1987;70:1718-21.

Young NS, Kaufman DW. The epidemiology of acquired aplastic anemia. Haematologica. 2008;93(4):489-92.

Egesie OJ, Joseph DE, Egesie UG, Ewuga OJ. Epidemiology of anemia necessitating bone marrow aspiration cytology in Jos. Niger Med J. 2009;50:61-4.

Rahim F, Islam AI, Hussain S, Khan M, Khattack TAK. Spectrum of hematologic disorders in children observed in 424 consecutive bone marrow aspirations/biopsies. Pak J Med Sci. 2005;21(4):276-9.

Ramírez-Lapausa M, Menéndez-Saldaña A, Noguerado-Asensio A. Extrapulmonary tuberculosis: an overview. Rev Esp Sanid Penit 2015;17: 3-11.