Spectrum of hematological disorders in bone marrow aspirate and biopsy at tertiary care hospital, Karachi

Abstract

Background: Bone marrow analysis is an invasive practice applicable to identifying, staging, and pursuing tumours. The present study aimed to determine the frequency of malignant hematological disorders using bone marrow aspirate and biopsy at Dr. Ishrat ul Ebad Khan Institute of Blood Diseases (DIEKIBD).
 Methodology: In this retrospective study, 756 patient records were examined for bone marrow analysis including both aspiration & biopsy, from January 2014 to December 2018. The posterior superior iliac crest was preferred for bone marrow sampling and aspiration was done with the help of a Salah bone marrow needle.
 Results: It was observed that about half of the bone marrow examinations, i.e. 362 (47%), were carried out for tumour staging. Of which 260 (71.8%) were not compromised by primary diseases, while 102 (28.17%) cases contained primary diseases. Among non-malignant hematological disorders, megaloblastic anemia and mixed deficiency anemia were the most frequent, i.e. 24 (3.1%) each. In comparison, chronic myeloid leukemia and chronic lymphocytic leukemia were the most prevalent malignant hematological disorders 42(5.5%) each.
 Conclusion: As per the study results, the pathological analysis of bone marrow via aspirate and trephine biopsy has comparatively more significant value in diagnosing and staging the malignant disorders than the non-malignant disorders.

Assessing donor site pain after Iliac Crest Bone Graft

“…Post-operative donor site pain has long been identified as the most frequently reported morbidity associated with autogenous iliac crest bone graft [6][7][8] . However, a recent study from Florida implied that the post-operative pain among patients who underwent iliac crest bone graft is usually over-reported.…”

“…Despite the high success rate, autogenous iliac crest bone graft harvesting also hampers certain risks like donor site morbidit-y. The reported complication rate ranges from 2.8% to 39% [5][6][7][8] . In comparison, other alternative procedures are expensive, less favourable biologically, and usually followed by a list of complications such as bone morphogenic proteins, etc 9 .…”

“…The existing data presents a great variation in donor site pain incidence rate after the iliac crest bone graft harvest [6][7][8][9]11,12 . Several studies indicate a high frequency of long-term donor site pain expe-rienced postoperatively after 2 years of the procedure.…”

“…One of the studies determined pain in the initial stages and concluded in favour of high-frequency pain, whereas it is known that the donor site pain usually improves over time. Therefore, such patients should be followed up for quite a time 7 . Furthermore, surgeons' and patients' pain perceptions greatly differ, as a study also identified greater pain intensity as per the surgeon's perception than the patient's 7 .…”

“…Therefore, such patients should be followed up for quite a time 7 . Furthermore, surgeons' and patients' pain perceptions greatly differ, as a study also identified greater pain intensity as per the surgeon's perception than the patient's 7 . But still, the pain has been determined by the chart review in most studies.…”