Diagnostic utility of bone marrow examination for the assessment of patients with fever of unknown origin: a 10‐year single‐centre experience

Abstract

Keywordsbone marrow, fever of unknown origin, diagnostic. Correspondence AbstractBone marrow (BM) examination is included in the diagnostic algorithm of fever of unknown origin (FUO), although its role is not clearly determined. The purpose of this study was to assess the role of BM studies in patients with FUO. We retrospectively reviewed 45 consecutive patients (25% human immunodeficiency virus-positive) with FUO who underwent a BM study in the University Hospital of Salamanca from 2000 to 2010. We analysed the diagnostic role of BM smears, multiparameter flow cytometry analysis, histology and microbiological cultures. Five patients (11%) were finally diagnosed by BM study (three had an infectious disease and two were found to have haematological malignancies), all of whom were immunocompetent patients. Histology was the most useful study (diagnosis was obtained in 4/5 patients), while BM cultures did not establish the final diagnosis in any patient. Flow cytometry established the diagnosis in one patient, although this patient was also diagnosed by histology.In conclusion, BM study is useful for establishing the aetiology of FUO. BM biopsy for histological examination should be always mandatory if a BM examination is performed.Fever of unknown origin (FUO) is defined as a temperature higher than 38.3°C determined on several occasions over 3 weeks duration, without an established diagnosis after at least 1 week of investigations in the hospital. 1 In addition to this definition, three new categories have been proposed: human immunodeficiency virus (HIV)-associated FUO, neutropenic FUO (neutrophils <500/ mm 3 ) and nosocomial FUO (3 days of fever without a diagnosis after 3 days of investigations). 2 In patients with prolonged fever, initial studies should be performed and have proved unrevealing prior to concluding that a patient has an FUO. Subsequently, specific studies should then be performed. Among these studies, bone marrow (BM) aspirate biopsy is one of the most frequently requested tests. Results of the very few studies published in this regard have shown a very low diagnostic yield for BM cultures and BM smear, and higher for BM biopsy. 3-5 However, the role of BM study is not clearly defined. Moreover, analysis of the BM studies associated with the highest diagnostic efficiency has not been well analysed.To shed further light on this matter, we performed a retrospective analysis to determine the role of different BM studies in patients with FUO. In addition, we aimed to identify clinical features predictive of a higher diagnostic yield.We retrospectively analysed 45 consecutive patients with FUO who underwent a BM study between January 2000 and December 2010 in the University Hospital of Salamanca. All patients fulfilling the diagnostic criteria of FUO, HIV-associated FUO, neutropenic FUO or nosocomial FUO as previously described were included. 1,2 Patients underwent the following tests prior to being considered eligible for the study: past medical history and physical examination, complete blood coun...

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

“…BMB has been shown to be useful in the diagnosis of malignancy and infection . In our cohort, BMB conferred a diagnosis of malignancy in five patients, however, the diagnoses in all these cases could have been made by biopsy of lesions seen on CT or FDG‐PET.…”

“…However, BMB were performed in relatively unselected patients in these studies, including those with cytopenias. In the Spanish study the authors acknowledged that some of the diagnoses could have been made by other means, without BMB . The French group found anaemia and thrombocytopenia to be more predictive of a positive finding from BMB …”

“…In the Spanish study the authors acknowledged that some of the diagnoses could have been made by other means, without BMB. 2 The French group found anaemia and thrombocytopenia to be more predictive of a positive finding from BMB. 3 The study by Wang et al 4 went a step further, devising a bone marrow score to guide the need for BMB in FUO for diagnosing haematological malignancy.…”

“…Previous studies have demonstrated the utility of BMB in FUO, helping to make the diagnosis of haematological malignancy or infection . However, BMB were performed in relatively unselected patients in these studies, including those with cytopenias.…”

“…Previous studies have demonstrated the utility of BMB in FUO, helping to make the diagnosis of haematological malignancy or infection. 2,3 However, BMB were performed in relatively unselected patients in these studies, including those with cytopenias. In the Spanish study the authors acknowledged that some of the diagnoses could have been made by other means, without BMB.…”