UTILITY OF BONE MARROW BIOPSY IN FEVER OF UNKNOWN ORIGEN: A CRITICAL ANALYSIS OF A RETROSPECTIVE SERIE.
(Abstract release date: 05/18/17)
EHA Library. Fernandez-Leyva H. 05/18/17; 182607; PB1893
Harberth Fernandez-Leyva
Contributions
Contributions
Abstract
Abstract: PB1893
Type: Publication Only
Background
The utility of bone marrow biopsy trephine (BMT) as a diagnostic tool in patients with fever of unknown origin (FUO) is a subject of controversy and debate. BMT has been shown to be safe and useful in patients with HIV/AIDS but its value in immunocompetent patients has not been sufficiently assessed. It’s reported the use of diagnostic BMT as a rapid decision-making tool in patients with HIV/AIDS and FUO in the proper clinical setting. A BMT demonstrated infection-related evidence prior to positive bone marrow culture in 75% of cases. Special stains and blood cultures had similar diagnostic yield, but BMT offers faster results. Thus, this procedure assists in clinical decision-making and the refinement of treatment in a more timely manner.
Aims
determine the utility of Bone marrow biopsy in FUO patients
Methods
We reviewed retrospectively the bone marrow biopsy results of the inpatients who underwent BMT from January 2010, to December 2016. Demographic, laboratory, diagnostic and outcome data were collected and retrospectively analyzed. We identified 31 patients who fulfilled the accepted classic Petersdorf criteria for FUO. The cohort included immunocompromise and immunocompetent patients.
Results
The BMT contributes to the diagnosis in only four cases (12.9 %). In two patients (6%) the histology revealed the presence of granuloma and/or lymphohistiocytic aggregates; one secundary hemophagocytosis (3.2%) and one mastocytes infiltrate (3.2%).
Six patients had a previous diagnosis of HIV/AIDS (19%). Sub analysis in HIV/AIDS patients revealed positive BMT culture in 2 of the patients (6,4%). Cultures demonstrated Mycobacterium tuberculosis and Mycobacterium avium intracellulare. There was one case in which a pathogen was grown in culture but that had a negative of 'direct examination'.
The associations most likely related factor to contribute to the diagnosis in HIV/AIDS was male predominance (58 % odds ratio [OR] 2.95; 95% CI, 1.19-4.25), clinical lymphadenopathy (OR 4.97; 95% CI, 1.90-2.44) or anemia (OR, 2.21; 95% CI, 1.26-3.84).
Reactive myeloid hyperplasia was represented 15 cases (48 %). Non- haematological diagnosis (lymphoma, Leukemia) was made on the exclusive bases of biopsy results.
Conclusion
Bone marrow examination is an integral part of investigation of FUO, however, morphological finding alone would not be sufficient to ascertain the diagnosis.
In present study only two cases of established infections (Mycobacterium) were detected on bases of the marrow culture. Both were present in HIV/AIDS. These results are explained because a highly active antiretroviral therapy has reduced incidence of opportunistic infections.
The percent of opportunistic infections diagnosed by BMT was very low and did not justify an invasive procedure. The presence of granulomas in trephine biopsy increases the likelihood of an aetiologic diagnosis in these patients.
Bone marrow biopsy is still a useful ancillary procedure for establishing the diagnosis of FUO, only if used in the adequate context.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Fever, Bone marrow biopsy
Abstract: PB1893
Type: Publication Only
Background
The utility of bone marrow biopsy trephine (BMT) as a diagnostic tool in patients with fever of unknown origin (FUO) is a subject of controversy and debate. BMT has been shown to be safe and useful in patients with HIV/AIDS but its value in immunocompetent patients has not been sufficiently assessed. It’s reported the use of diagnostic BMT as a rapid decision-making tool in patients with HIV/AIDS and FUO in the proper clinical setting. A BMT demonstrated infection-related evidence prior to positive bone marrow culture in 75% of cases. Special stains and blood cultures had similar diagnostic yield, but BMT offers faster results. Thus, this procedure assists in clinical decision-making and the refinement of treatment in a more timely manner.
Aims
determine the utility of Bone marrow biopsy in FUO patients
Methods
We reviewed retrospectively the bone marrow biopsy results of the inpatients who underwent BMT from January 2010, to December 2016. Demographic, laboratory, diagnostic and outcome data were collected and retrospectively analyzed. We identified 31 patients who fulfilled the accepted classic Petersdorf criteria for FUO. The cohort included immunocompromise and immunocompetent patients.
Results
The BMT contributes to the diagnosis in only four cases (12.9 %). In two patients (6%) the histology revealed the presence of granuloma and/or lymphohistiocytic aggregates; one secundary hemophagocytosis (3.2%) and one mastocytes infiltrate (3.2%).
Six patients had a previous diagnosis of HIV/AIDS (19%). Sub analysis in HIV/AIDS patients revealed positive BMT culture in 2 of the patients (6,4%). Cultures demonstrated Mycobacterium tuberculosis and Mycobacterium avium intracellulare. There was one case in which a pathogen was grown in culture but that had a negative of 'direct examination'.
The associations most likely related factor to contribute to the diagnosis in HIV/AIDS was male predominance (58 % odds ratio [OR] 2.95; 95% CI, 1.19-4.25), clinical lymphadenopathy (OR 4.97; 95% CI, 1.90-2.44) or anemia (OR, 2.21; 95% CI, 1.26-3.84).
Reactive myeloid hyperplasia was represented 15 cases (48 %). Non- haematological diagnosis (lymphoma, Leukemia) was made on the exclusive bases of biopsy results.
Conclusion
Bone marrow examination is an integral part of investigation of FUO, however, morphological finding alone would not be sufficient to ascertain the diagnosis.
In present study only two cases of established infections (Mycobacterium) were detected on bases of the marrow culture. Both were present in HIV/AIDS. These results are explained because a highly active antiretroviral therapy has reduced incidence of opportunistic infections.
The percent of opportunistic infections diagnosed by BMT was very low and did not justify an invasive procedure. The presence of granulomas in trephine biopsy increases the likelihood of an aetiologic diagnosis in these patients.
Bone marrow biopsy is still a useful ancillary procedure for establishing the diagnosis of FUO, only if used in the adequate context.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Fever, Bone marrow biopsy
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