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PubMed2004

Cryptococcal sepsis diagnosed by bone marrow examination.

Disseminated cryptococcal disease is often associated with immunodeficient states. The diagnosis is usually made using standard antigen tests on serum and cerebrospinal fluid in patients with known immunodeficiency. Often, blood and cerebrospinal fluid cultures also yield Cryptococcus neoformans. The authors describe a child whose diagnosis remained elusive until a bone marrow aspiration, performed as part of an evaluation for suspected neoplasm, revealed the offending organism.

Bone Marrow↗
PubMed1999

[The usefulness of the bone marrow examination in the etiological diagnosis of prolonged fever in patients with HIV infection].

BACKGROUND: To analyze the usefulness of bone marrow (BM) study in the diagnosis of fever of unknown origin (FUO) in patients infected by the human immunodeficiency virus (HIV) in a single center during a period of 42 months. PATIENTS AND METHODS: 182 episodes of FUO in 162 patients p3th HIV infection were studied. Age, sex, risk factor for HIV infection, hemoglobin level, counts of leucocytes, neutrophils, lymphocytes, CD4 positive lymphocytes, platelets and levels of hepatic enzymes, albumin and beta 2-microglobulin were studied. BM aspirate was performed in all episodes for cytologic and microbiologic examination, and BM biopsy was done in 43. Analysis of factors related with the probability of diagnosis by BM examination was carried out. RESULTS: The median age was 33 years (range, 22-70), and 123 were males. Drug abuse was the most frequent risk factor for HIV infection (63%). One hundred thirty patients had previous AIDS diagnosis before they were evaluated for unexplained fever. A specific diagnosis was achieved in 161 episodes (88%) and the most frequent diagnoses were Mycobacterium spp. (55%) and Leishmania spp. (14%) infections. Fifty-four episodes (30%) were diagnosed by BM examination, and in 36 (20%) BM study was the only diagnostic tool. Examination of the BM aspirate yielded the diagnosis in 40 out of the 178 episodes (13%), whereas BM biopsy was a diagnostic tool in 8 (19%); in 9 additional cases (21%) granulomas were observed. Microbiologic study of BM smears for mycobacterial infections was positive in 28 of the 143 episodes (19%), and the culture for Leishmania was positive in 2 out of the 42 cases. The presence of thrombocytopenia (< 75 x 10(9)/l) and elevated serum levels of aspartate-aminotransferase (AST) (> 100 U/l) were the factors associated with a high probability to obtain the diagnosis through BM study. CONCLUSIONS: In patients infected by the HIV and unexplained fever, BM examination is an useful procedure for the diagnosis, particularly in areas where infections by Mycobacterium spp. and Leishmania are prevalent. So that, in our setting, systematic use of this procedure is justified for diagnosis of FUO in those patients.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Significance of bone marrow examination in the diagnostic process of paraspinal mass in children: a case report.

Spinal cord compression is a rare but serious complication of non-Hodgkin lymphoma or leukemia. Biopsy of the mass with or without laminectomy would be necessary for diagnosis in patients presenting with isolated paraspinal mass in the absence of other overt clinical symptoms or findings or laboratory abnormalities that would specifically suggest leukemia or lymphoma. The authors describe a 6-year-old girl with symptoms of spinal cord compression due to a paraspinal mass who had undergone surgical intervention; she was later shown to have acute B-cell lymphoblastic leukemia. A bone marrow aspiration should be considered in such patients to avoid unnecessary surgical intervention.

Bone Marrow↗
PubMed1988

Bone marrow examination in the diagnosis of acute and chronic leukemias.

This article presents a brief review of the morphologic and cytochemical features of acute and chronic leukemias, followed by a discussion about new techniques that can be applied to the diagnosis of leukemias. The four techniques described include immunophenotyping, DNA content and cell cycle analysis, cytogenetics, and molecular studies. The utility of these specialized techniques in establishing a diagnosis of leukemia and in predicting prognosis is presented.

Antigens, Surface↗
PubMed2004

Parvovirus B19-associated transient red cell aplasia in children: the role of bone marrow examination in unusual presentations.

Human parvovirus B19 (PV B19) infection in children commonly presents as fifth disease. Transient red cell crisis, the other manifestation of PV B19 infection, is usually reported in children with chronic hemolytic anemia, with a worsening of the anemia. However, this condition may pass unrecognized in children without an underlying hemolytic disorder, since the anemia may be of a short duration and self-limiting. The authors report 3 cases of PV B19-induced transient aplastic in different clinical settings--pancytopenia in one child, during induction phase for acute lymphoblastic leukemia in the second, and fever with joint pains in the third. Treatment for PV B19-induced transient aplastic crisis is essentially supportive. There may be a dilemma in patients on immunosuppressive therapy, since initially it is difficult to distinguish between chronic pure red cell aplasia (a condition where intravenous immunoglobulin therapy is beneficial) and transient aplastic crisis, where supportive red cell transfusions suffice. The patient with leukemia also recovered spontaneously despite being on steroids. In all the 3 patients, the pure red cell aplasia recovered spontaneously without administration of intravenous gammaglobulins.

Bone Marrow Examination↗
PubMed1988

Cytochemistry and immunocytochemistry in bone marrow examination: contemporary techniques for the diagnosis of acute leukemia and myelodysplastic syndromes. A combined approach.

Although the cytologic type of acute leukemia can often be suspected on the basis of conventional panoptically stained specimens, it is important to document as precisely as possible the type of leukemia before the institution of specific treatment. At the present time, this documentation can usually be achieved with cytochemical stains that demonstrate enzymes and/or metabolites of diagnostic value. Additional immunocytochemical stains can often identify cells of ambiguous origin on the basis of cell-specific properties such as antigens. Immunophenotyping has proven to be of considerable value in the diagnosis and classification of ALL. At present, the practicality of surface antigen phenotyping in ANLL remains to be documented. The identification of hybrid leukemia is clearly facilitated with immunologic markers. Present criteria for the diagnosis of myelodysplastic syndrome do not include immunophenotyping. By use of a combination of morphologic criteria, traditional cytochemical stains, and immunocytochemical techniques, it is possible to establish the cell of origin in the large majority of cases of acute leukemia. Those rare cases in which the usual patterns of reactivity do not occur provide additional stimuli to develop new cytochemical and immunologic methods that will help to establish the origin of the leukemic blast.

Bone Marrow↗
PubMed1993

Screening for iron deficiency: an analysis based on bone-marrow examinations and serum ferritin determinations in a population sample of women.

Efficacy of different methods in screening for iron deficiency was re-examined in a randomly selected sample of 38-year-old women (n = 203) with known iron status based on absence/presence of stainable iron in bone-marrow smears. The study was made in 1968-69. Serum ferritin (SF) was determined in 1978 in frozen sera using the Ramco IRMA and, in 1992, samples were re-analysed using a RIA calibrated with the International Standard 80/602 for SF determination. The effect of storage on SF was calculated from a previously established relationship (courtesy of Dr Mark Worwood, Cardiff) between the results obtained with the Ramco assay and assays calibrated with IS 80/602. The distributions in iron replete and iron deficient women showed less overlap (diagnostic efficiency 91%) for SF than for other haematological parameters. The best discrimination was obtained at SF < 16 micrograms/l (specificity 98%; sensitivity 75%). Absence of iron stores was associated with signs of an iron deficient erythropoiesis, starting already at SF 25-40 micrograms/l. Use of multiple criteria to diagnose iron deficiency falsely reduces prevalence figures for iron deficiency.

Adult↗