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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 119-122

Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria


1 Department of Haematology and Blood Transfusion, Gombe State University, Gombe, Gombe State, Nigeria
2 Department of Haematology and Blood Transfusion, Abubakar Tafawa Balewa University Bauchi, Bauchi State, Nigeria
3 Department of Histopathology, Gombe State University, Gombe, Gombe State, Nigeria

Date of Submission04-Mar-2020
Date of Decision26-Apr-2019
Date of Acceptance11-Jun-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Saleh Yuguda
Department of Haematology and Blood Transfusion, Gombe State University, Gombe, Gombe State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atp.atp_15_20

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  Abstract 

Background: Bone marrow aspiration (BMA) cytology is very important in the diagnosis and management of a wide range of both hematological and nonhematological disorders. It has several indications ranging from the evaluation of cytopenias to staging and assessment of remission in the course of management. Aim: The aim of the study was to determine the indications and diagnostic utility of BMA cytology at the Federal Teaching Hospital, Gombe, Gombe State, Nigeria. Methodology: A retrospective review of BMA cytology records performed at the department of Haematology and Blood Transfusion of the Federal Teaching Hospital, Gombe, over a 12-year period from January 1, 2006, to December 31, 2017. Results: A total of 596 BMAs were performed over the study period. The age ranges were from 2 months to 88 years, with a median age of 36 years. Majority of the patients were males (61%). The most common indication for the bone marrow examination was for the evaluation of recurrent anemia 32.2%, followed by presumptive diagnosis of leukemia 27.7%. Normal marrow finding constituted 4.7%, while the diagnosis was inconclusive in 4.2% of the cases. The most frequently diagnosed diseases are the nutritional deficiency anemia together accounting for about one-third of the cases (megaloblastic anemia 20.3%, combined deficiency anemia 9.9%, and iron deficiency anemia 2.5%) and leukemia. Conclusion: Anemia and leukemia are the most common indication for BMA, and nutritional deficiency anemia is the major BMA diagnosis in Gombe, Northeastern Nigeria.

Keywords: Anemia, bone marrow aspiration, indications, leukemia


How to cite this article:
Yuguda S, Girei AI, Pindiga KM, Dachi RA, Lawan AI, Abdullahi YM. Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria. Ann Trop Pathol 2020;11:119-22

How to cite this URL:
Yuguda S, Girei AI, Pindiga KM, Dachi RA, Lawan AI, Abdullahi YM. Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria. Ann Trop Pathol [serial online] 2020 [cited 2021 Jun 21];11:119-22. Available from: https://www.atpjournal.org/text.asp?2020/11/2/119/305682


  Introduction Top


Examination of the marrow through aspiration with or without biopsy is an indispensable adjunct to the diagnosis and monitoring of care for both hematological and nonhematological disorders.[1],[2] The bone marrow sample can be obtained either by needle aspiration or percutaneous trephine biopsy from the iliac crest, anterior or posterior iliac spines, the tibial tuberosity, or the sternum commonly under local anesthesia.[1] The posterior iliac spines are the most preferred sites for marrow biopsy in adults.[1] The procedure is relatively easy, and complications are less encountered if performed by an experienced hand under strict aseptic measures. Complications such as pain, hemorrhage, infections, and rarely arteriovenous fistulae have been reported.[3] In addition to the cytological examination of the marrow aspirate, other more advanced tests such as cytogenetic and immunophenotypic analyses can also be performed on the sample.[4] There are several indications for bone marrow examination ranging from the evaluation of cytopenias to staging of both hematological and nonhematological malignancies as well as assessment of remission in the management of hematological malignancies. Currently, there is a paucity of reports of bone marrow aspiration (BMA) from this part of the country. The aim of this study was to report the various indications of bone marrow examination in our center as well as the wide spectrum of diseases diagnosed.


  Methodology Top


This was a retrospective review of BMA record registers in the Department of Haematology and Blood Transfusion of the Federal Teaching Hospital, Gombe, Gombe State, over a 12-year period from January 1, 2006, to December 31, 2017. The records of age, sex, indications, and final diagnosis were reviewed, and the data obtained were analyzed using IBM SPSS version 20.0 (Chicago, IL. USA. 2012). All the diagnoses were made based on morphology.

Protocol for bone marrow aspiration

The patient is counseled appropriately and allowed to lie on the left lateral position. Then, the posterior superior iliac spine (the preferred site in adults) is located after the patient is exposed appropriately. The skin over the posterior superior iliac spine is then cleaned with 70% alcohol or 0.5% chlorhexidine.

The skin is then infiltrated together with the subcutaneous tissue and periosteum over the selected site with 2–5 ml of 2% lignocaine and then waited for 3–5 min until anesthesia has been achieved.

With a boring movement, the bone marrow needle is passed perpendicularly into the cavity of the bone. When the bone has been penetrated, the stillette is removed, and a 5 or 10 ml syringe is attached to aspirate 0.3 ml and make 7–10 smears immediately. Without coming out of the skin, the stillette is reintroduced and then another site on the bone is chosen, and a boring motion is commenced again for biopsy. The stillete is then removed once you feel a resistance and continue boring until you isolate a core. Gently rock the needle horizontally and vertically and then the needle is removed slowly.

An introducer is then used to dislodge the isolated core onto a slide to make an imprint by gently rolling the core on slides. The core biopsy is then transferred into formaline solution. All slides are labeled appropriately.


  Results Top


A total of 596 BMAs were performed over the study period. [Figure 1] shows the number of BMAs performed per year during the study period. The age ranges were from 2 months to 88 years, with a median age of 36 years (quartile range of 20–53 years). Males (61%) constituted the majority of the patients. [Table 1] shows the indications for the bone marrow examination with evaluation of various degrees of cytopenias accounting for the majority (anemia 32.2%, pancytopenia 5.4%, thrombocytopenia 4.7%, and bicytopenia [anemia and thrombocytopenia] 3.2%) followed by leukemia, 27.7% (165/596).
Figure 1: Twelve-year distribution of bone marrow examination in FTH Gombe

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Table 1: Indications for bone marrow examination at FTH Gombe (2006-2017)

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[Table 2] shows the frequencies of diagnoses made from the BMA cytology. The most frequently diagnosed diseases are the nutritional deficiency anemia constituting about one-third of the cases (megaloblastic anemia 20.3% (121), combined deficiency anemia 9.9% (59), and iron deficiency anemia 2.5% [14]). Normal marrow finding constituted 4.7% (28), while the diagnosis was inconclusive in 4.2% (25) of the cases. [Table 3] shows the various frequencies of the diagnoses based on the age groups.
Table 2: Bone marrow aspiration cytology diagnoses at FTH Gombe (2006-2017)

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Table 3: Frequencies of bone marrow aspiration cytology diagnosis based on age groups at FTH Gombe (2006-2017)

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  Discussion Top


BMA is an indispensable adjunct to the diagnosis and monitoring of care for hematological disorders.[1] Satisfactory samples of bone marrow can usually be aspirated from the sternum and tibial tuberosity in children and from iliac crest or the iliac spines in adults. This study reports the experience of Federal Teaching Hospital Gombe, Gombe State, Northeastern Nigeria, over a 12-year period. The upward trend observed in the number of BMAs done annually throughout the period could be explained by the availability of the specialist hematologists in FTH Gombe as there was only one hematologist in 2006 and three as at the end of 2017. This could also be explained by the awareness among doctors in the region which led an increase in hematologic referrals being the second center with functional hematology clinical services department in the entire Northeastern region of the country during this period.

The study revealed a male predominance, and this finding is similar to what was reported by Dachi et al . in Bauchi, Awwalu et al . in Zaria, Northwestern Nigeria, and Egesie et al . in Jos, North-Central Nigeria.[5],[6],[7] The age range and the mean age of the study participants in this study agree to what was reported in many studies, both within and outside Nigeria.[5],[6],[7],[8],[9] The reason for the wide age range can be due to the fact that blood cell formation starts in utero and continues throughout the life of an individual, and so disease conditions can come anytime in the lifetime of an individual.

Evaluation of recurrent anemia necessitating blood transfusion is the major indication for BMAs in this study. This agrees with the reports of Dachi et al . in Bauchi, Northestern Nigeria; Awwalu et al . in Zaria, Northwestern Nigeria, Damulak and Damen in Jos, North-Central Nigeria; and Gohil and Rathod, in Gujarat, India.[5],[6],[9],[10] This is in contrast to Elmadhoun's finding of pancytopenia as the major indication for BMA.[11] This difference could be explained by the type and severity of the disease at the time of presentation as some conditions can present with unicytopenia as recurrent anemia and some bicytopenias such as anemia and thrombocytopenia or pancytopenia, and it is only the bone marrow examination that finally determines the diagnosis.

The frequently encountered nutritional anemia in this study was megaloblastic anemia, and this finding is in tandem with what was obtained in Bauchi, a neighboring state, as well as in Gujarat, India, and Nairobi, Kenya.[5],[9],[12] However, Bedu-Addo et al . in Ghana reported lymphoproliferative disorder as the most common BMA diagnosis,[8] while both Weinzierl and Arber and Bashawri in the USA and Saudi Arabia showed leukemia as the most commonly diagnosed condition.[13],[14] The reason for nutritional anemia being the most common diagnosis is not surprising taking the economic situation of Northeastern Nigeria as malnutrition is highly prevalent in developing countries such as Nigeria, and the Northeastern part of the country is the second-most affected region owing to low literacy rate and high poverty profile as reported in the Nigeria Poverty Profile report 2010 and National Literacy Survey 2010 coupled with the Boko Haram insurgency that has ravaged the region.[15],[16] This has led to the emergence of many internally displaced persons and reduction in agricultural and economic activities, hence the high tendency of micronutrient deficiency.[17] The findings of normal BMA in this study are similar to what was found in Bauchi and lower than the values reported in India, Ghana, and Zaria.[5],[6],[8],[9]

Limitation of the study

The major limitation of this study is that the diagnoses were based on morphology.


  Conclusion Top


Evaluations of anemia and leukemia are the most common indications for BMA, and nutritional deficiency anemia is the major BMA diagnosis in Gombe, Northeastern Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bain BJ, Bates I, Laffan MA, Lewis MS. Practical Haematology. 11th ed. Churchil Livingstone Inc. Philadelphia USA. 2012. p. 116-30.  Back to cited text no. 1
    
2.
Mahajan V, Kaushal V, Thakur S, Kaushik R. A comparative study of bone marrow aspiration and bone marrow biopsy in hematological and non-hematological disorders- an institutional experience. JIACM 2013;14:133-5.  Back to cited text no. 2
    
3.
Berber I, Erkurt MA, Kuku I, Kaya E, Kutlu R, Koroglu M, et al . An unexpected complication of bone marrow aspiration and trephine biopsy: Arteriovenous fistula. Med Princ Pract 2014;23:380-3.  Back to cited text no. 3
    
4.
Bain BJ. Bone marrow aspiration. J Clin Pathol 2001;54:657-63.  Back to cited text no. 4
    
5.
Dachi RA, Mustapha FG, Yuguda S, Kagu MB, Gwaram AA, Bwala P. Bone marrow aspiration cytology in Abubakar Tafawa Balewa Teaching Hospital Bauchi, Bauchi State: Indications and diagnostic utility. Annals Afr Med Res 2019;2:16-9.  Back to cited text no. 5
    
6.
Awwalu S, Hassan A, Dogara LG, Musa AU, Waziri AD, Babadoko AA. Bone marrow aspiration (BMA) in Zaria: A 3 year restrospective review. Bio Med J 2016;3:54-5.  Back to cited text no. 6
    
7.
Egesie OJ, Joseph DE, Egesie UG, Ewuga OJ. Epidemiology of anaemia necessitating bone marrow aspiration cytology in Jos. Niger Med J 2010;50:61-3.  Back to cited text no. 7
    
8.
Bedu-Addo G, Ampem AY, Bates I. The role of bone marrow aspiration and trephine samples in haematological diagnosis in patients referred to a teaching hospital in Ghana. Ghana Med J 2013;47:74-8.  Back to cited text no. 8
    
9.
Gohil M, Rathod K. Bone Marrow Aspiration Cytology Study in a Tertiary Care Center, Gujarat, India. Int J Sci Stud 2018;5:11-4.  Back to cited text no. 9
    
10.
Damulak O, Damen J. Diagnostic outcome of Bone marrow aspiration in a new centre in Nigeria. Global Adv Res Jnl Med Med Sci 2012;1:166-71.  Back to cited text no. 10
    
11.
Elmadhoun WM, Noor SK, Bushara SO, Almobarak AO, Husain NE, Ahmed MH. Bone marrow aspiration in north Sudan: The procedure, indications and the diagnostic value. Int J Health Sci (Qassim) 2015;9:434-9.  Back to cited text no. 11
    
12.
Okinda NA, Riyat MS. Bone marrow examination findings at Aga Khan University Hospital, Nairobi. East Afr Med J 2010;87:4-8.  Back to cited text no. 12
    
13.
Weinzierl EP, Arber DA. Bone marrow evaluation in new-onset pancytopenia. Hum Pathol 2013;44:1154-64.  Back to cited text no. 13
    
14.
Bashawri LA. Bone marrow examination. Indications and diagnostic value. Saudi Med J 2002;23:191-6.  Back to cited text no. 14
    
15.
Federal Republic of Nigeria: Poverty Indicators. Nigeria Poverty Profile. Report No.: 2.6; 2010. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/b410c26c2921c18a6839baebc9b1428fa98fa36a.pdf. [Last accessed on 2020 Jan 12].  Back to cited text no. 15
    
16.
National Bureau of Statistics. The Nigeria National Literacy Survey 2010. Report No.: 3.4; 2010. Available from: http://www.nigerianstat.gov.ng/pdfuploads/National%20Literacy%20Survey,%202010.pdf. [Last accessed on 2020 Jan 12].  Back to cited text no. 16
    
17.
Afolabi A. The insurgence and socio-political economy in Nigeria. Int J Dev Econ Sustain 2015;3:61-74.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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