Indications for bone marrow examinations in rheumatology
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Hematologic involvement or hematologic malignancies are frequently encountered during the course of rheumatic diseases. Bone marrow (BM) aspiration and/or biopsy examinations may have a diagnostic role in explaining hematologic findings detected in rheumatology clinical practice. Our aim was to describe the indications for BM examinations and to share our BM aspiration/biopsy results. We analyzed 140 BM aspiration/biopsy results of patients conducted at the Department of Rheumatology from 2010 to 2018. Demographics, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values, serum biochemistry test results including lactate dehydrogenase (LDH), organomegaly, indications for BM examinations and BM examination results for each patient, and mortality rates were recorded. Out of the 140 patients, 63.6% were female, and the median (Q1–Q3) age was 53 (39.5–65) years. One hundred fifteen (82.1%) patients were diagnosed as having primary rheumatic disease, and 25 (17.8%) were admitted due to musculoskeletal symptoms. Rheumatoid arthritis (RA) (n = 34, [29.5%]), and systemic lupus erythematosus (SLE) (n = 21, [18.2%]) were the most common rheumatic diseases. Cytopenia was the most common indication for BM aspiration/biopsy (n = 83, [59.3%]). Thirty-nine (47%) of 83 patients had drug-induced cytopenia. A pathology was detected in 40 (28.5%) of the 140 BM examinations. Patients with pathologic BM results had either a hematologic malignancy (n = 38, [95%]) or metastasis to a solid organ (n = 2, [5%]). The group of patients with pathologic BM biopsy results had significantly higher rates of lymphadenopathy, splenomegaly, and monoclonal gammopathy compared with the group with non-pathologic results (p = 0.001, p = 0.011, and p = 0.023, respectively). Likewise, LDH concentrations of those with pathologic results were higher than in patients with non-pathologic results [737 (range 577–1420) IU/L vs. 541 (range 306–840) IU/L, p = 0.019]. In this study, cytopenia or CBC abnormalities accompanied by elevated LDH values or anemia along with increased ESR were the most common indications for BM aspiration/biopsy. Further prospective studies are needed to determine the indications of BM aspiration/biopsy and establish the parameters that predict abnormal BM results in rheumatology practice.
KeywordsBone marrow examination Rheumatology Cytopenia
HUT and DUC designed, collected the data and analyzed the results, HUT, DUC and CK wrote the manuscript, critically reviewed the manuscript and wrote the final version. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was not obtained from the patients since ethics committee did not ask for it in such studies processing medical records anonymously.
Written informed consent was not obtained from the patients since ethics committee did not ask for it in such studies processing medical records anonymously.
- 3.Bain BJ (2006) Morbidity associated with bone marrow aspiration and trephine biopsy: a review of UK data for 2004. Haematologica 91:1293–1294Google Scholar
- 9.Papageorgiou A, Ziakas PD, Tzioufas AG, Voulgarelis M (2013) Indications for bone marrow examination in autoimmune disorders with concurrent haematologic alterations. Clin Exp Rheumatol 31:76–83Google Scholar
- 11.Esatoglu SN, Hatemi G, Salihoglu A, Hatemi I, Soysal T, Celik AF (2015) A reappraisal of the association between Behçet’s disease, myelodysplastic syndrome and the presence of trisomy 8: a systematic literature review. Clin Exp Rheumatol 33(6 Suppl 94):S145–S151Google Scholar