The diagnostic utility of bone marrow examination in an infectious disease ward

Abstract

Background: Patients with advanced human immunodeficiency virus often present with unexplained fevers or cytopenias. Bone marrow aspirate and trephine examinations are an invasive means to aid diagnoses in patients who present with diagnostic dilemmas. Objectives: A retrospective record review to assess the diagnostic utility of bone marrow examinations in a South African Infectious Diseases ward. Methods: The records of patients who had undergone a bone marrow examination in the Infectious Disease ward at the Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, between 01 January 2012 and 31 December 2014 were reviewed. A unique diagnosis was considered to be any diagnosis made on bone marrow examination alone, or a diagnosis made more timeously on bone marrow examination than with alternative investigations. Results: Of 327 patients who underwent bone marrow examination, 80 unique diagnoses were obtained in 77 cases (23.5%). The unique diagnoses included the presence of granuloma (n = 49), Mycobacterium tuberculosis (n = 17), Mycobacterium avium complex (n = 3), haematological malignancy (n = 4) and pure red cell aplasia (n = 5). A white cell count ≤ 4 × 109/L predicted a unique outcome (p < 0.01). A white cell count ≤ 4 × 109/L and CD4 cell count ≤ 50 cells/mm3 predicted mycobacterial infection of the bone marrow. Conclusions: The findings of a unique diagnosis in 23.5% of bone marrow examinations performed suggests that this remains a useful investigative modality in patients in whom less invasive investigations have not yielded a diagnosis.