Indications and diagnostic value of bone marrow examination in HIV-positive individuals: A 3-year review at Tygerberg Hospital

Abstract

Background Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital. Methods A retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured. Results Altogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients’ median age was 43 years and the interquartile range was 27–60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia. Conclusion Bone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.

The value of bone marrow examinations performed in the investigation of HIV infected patients with cytopenias

“…The overall diagnostic yield of 32% in this study is comparable to other studies which encompassed all indications for BME in HIV‐infected patients. The diagnostic yields ranged from 19% to 47% in those studies 10–18 . Our diagnostic yield was slightly higher than the range of 14.8% to 30.5% reported where the main or only indication was cytopenia in an HIV‐infected patient 10,11,14–16 .…”

“…Bone marrow (BM) aspirate and trephine biopsy together with adjunctive investigations, herein referred to as BM examination (BME), may be utilised to investigate HIV‐infected patients with unexplained cytopenia 10–18 . International studies show that the diagnostic yield (the percentage of cases in which a diagnosis is made) of BME in HIV‐infected adults ranges from 19 to 47%.…”

“…International studies show that the diagnostic yield (the percentage of cases in which a diagnosis is made) of BME in HIV‐infected adults ranges from 19 to 47%. 10–18 Where the main or only indication for BME was cytopenia in an HIV‐infected person, diagnostic yields of 14.8 to 30.5% were reported 10,11,14–16 …”

“…[6][7][8][9] Bone marrow (BM) aspirate and trephine biopsy together with adjunctive investigations, herein referred to as BM examination (BME), may be utilised to investigate HIV-infected patients with unexplained cytopenia. [10][11][12][13][14][15][16][17][18] International studies show that the diagnostic yield (the percentage of cases in which a diagnosis is made) of BME in HIV-infected adults ranges from 19 to 47%. [10][11][12][13][14][15][16][17][18] Where the main or only indication for BME was cytopenia in an HIV-infected person, diagnostic yields of 14.8 to 30.5% were reported.…”

“…[10][11][12][13][14][15][16][17][18] International studies show that the diagnostic yield (the percentage of cases in which a diagnosis is made) of BME in HIV-infected adults ranges from 19 to 47%. [10][11][12][13][14][15][16][17][18] Where the main or only indication for BME was cytopenia in an HIV-infected person, diagnostic yields of 14.8 to 30.5% were reported. 10,11,[14][15][16] Unique diagnostic yields for BME in patients infected with HIV range from 24-33%.…”