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Objectives Measurable residual disease flow cytometry (MRD-FC) and molecular studies are the most sensitive methods for detecting residual malignant populations after therapy for TP53 -mutated acute myeloid leukemia and myelodysplastic neoplasms (TP53+ AML/MDS). However, their sensitivity is limited in suboptimal aspirates or when the immunophenotype of the neoplastic blasts overlaps with erythroids or normal maturing myeloid cells. In this study, we set out to determine if p53 immunohistochemistry (IHC) correlates with MRD-FC and next-generation sequencing (NGS) in the posttherapy setting and to determine the utility of p53 IHC to detect residual disease in the setting of negative or equivocal MRD-FC. Methods We retrospectively identified 28 pre- and posttherapy bone marrow biopsy specimens from 9 patients with TP53+ AML/MDS and a p53 overexpressor phenotype by IHC (strong 3+ staining at initial diagnosis). Next-generation sequencing and/or MRD-FC results were collected for each specimen. Results Using a threshold of more than ten 2-3+ cells in any one 400× field, p53 IHC detected residual disease with a sensitivity of 94% and a specificity of 89%. The threshold used in this study showed a high degree of concordance among 6 blinded pathologists (Fleiss κ = 0.97). Conclusions Our study suggests that p53 IHC can be used as a rapid tool (within 24 hours) to aid in the detection of residual disease that may complement MRD-FC or NGS in cases in which the flow cytometry immunophenotype is equivocal and/or the bone marrow aspirate is suboptimal. [ABSTRACT FROM AUTHOR]

Objectives of the Study: (1) To evaluate the effect of platelet-rich fibrin (PRF) with bone marrow aspirate on regenerative capacity in patients undergoing iliac bone grafting for secondary alveolar bone grafting. (2) and to compare it with group 2 where only bone marrow aspirate was used along with iliac bone graft in secondary alveolar bone grafting. Materials and Methods: A prospective study on patients with cleft alveolus, requiring bone grafting and reporting to our unit from October 2018 to October 2020 was included in this study. Group 1 (bone marrow aspirate with PRF along with cancellous iliac bone graft) and Group 2 (bone marrow aspirate concentrate and cancellous Iliac bone graft without PRF). Computerized tomography (CT) scan was done to assess the volume of defect at the following intervals: Pre-op, immediate post-op, and 12 months. The outcome is assessed using a CT scan by statistical analysis. Results: Mean cleft alveolus volume measured preoperatively in group 1 was 2.5cc, post-operatively measured immediately was 3.2cc, and 12 months post-operative was 2.2cc. Mean volume defect in group 2 is 2.3cc, post-operatively measured immediately was 2.6 cc, and 12 months post-operative was 1.9cc. The average resorption rate at immediate post-op to 12 months interval in group 1 was 25% and in group 2 was 30%. The overall percentage of regenerated bone in group 1 was 75% whereas in group 2 it was 70%. Conclusion: Platelet-rich fibrin in combination with bone marrow aspirate and autogenous bone was beneficial in improving the volume of newly formed bone in the reconstruction of the cleft defect and also results in greater osteogenic effect which increases new bone regeneration and better wound healing. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyse the diagnostic value of bone marrow aspiration (BMA) in a retrospective cohort of patients with suspected immune thrombocytopaenia (ITP). We further measure changes in the percentage of patients who underwent this study and whether testing or not was in accordance with current guidelines at the time of diagnosis. We conducted a chart review of 243 patients with ITP who underwent follow-up in our institution between 1995 and 2022. The patients were divided into historical cohorts based on the practice guidelines of the Spanish Society of Pediatric Hematology and Oncology (SEHOP) and the American Society of Hematology (ASH) in place at the time of follow-up. For each case, time of disease presentation or initial diagnosis was defined as that which occurred in the first 72 h following disease onset. Based on data from the historical cohorts studied, we observed a lower total number of BMAs at diagnosis over time (p < 0.005). A gradual reduction was seen in the number of BMAs with the introduction of guidelines, including a progressively lower number of BMAs performed without indication (p < 0.05). Subsequent to the initial diagnosis, the procedure played a decisive role in only 2 patients (0.58%), allowing for a diagnosis of acquired aplastic anaemia in both cases. In both of them on diagnosis, BMA did not appear to be indicated, although subsequent analysis after 72 h raised suspicion of bone marrow failure. Conclusion: BMA at presentation did not significantly alter the diagnosis in our cohort of patients with an initial suspicion of ITP, although the procedure was decisive in diagnosing 2 cases of acquired aplastic anaemia during the subsequent course of the disease. Regarding the number of aspirations performed, our findings show that increased physician compliance with current guidelines reduced the rate of unnecessary BMAs. What is Known: • BMA is a supplementary test for the diagnosis of ITP. • The usefulness of this invasive diagnostic procedure is not clearly stated in current guidelines. What is New: • Adjustments to scientific guidelines have led to a reduction in the number of BMAs performed on our patients with suspected ITP in the last 27 years. • While the risks and benefits of BMA at the time of diagnosis are unclear in patients with suspected ITP, the procedure does not contribute significant information to support the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Congenital dyserythropoietic anemias (CDA) type II is a rare hereditary chronic hemolytic anemia due to a defect in the SEC23B gene which shows varying degrees of ineffective erythropoiesis and is often misdiagnosed as a red blood cell (RBC) membranopathy or enzymopathy. Case report: A five-year-old boy was admitted with increasing paleness for one month. Examination revealed pallor, icterus, and hepatosplenomegaly. Based on the peripheral blood smear findings, increased osmotic fragility of RBCs and a suggestive eosin-5′-maleimide binding test, the initial diagnosis was hereditary spherocytosis. However, the bone marrow aspirate suggested CDA. Next-generation sequencing revealed a SEC23B-Y462C homozygous mutation in exon 12 confirming CDA type II. Conclusion: CDAs are often underdiagnosed since the morphological abnormalities and clinical features resemble other hemolytic anemias. In this case, we demonstrate approach to diagnosis, highlighting the interpretation of the laboratory investigations and a timely bone marrow examination.

This double-blinded randomized controlled trial included 46 children between 4 to 12 years of age with haematological malignancy, scheduled for bone marrow examination at tertiary care hospital of India. Subjects were enrolled into two groups (23 each) by stratified random sampling based on the type of procedure scheduled to them. The maternal voice was recorded for 3 minutes before the procedure and headphones was placed during the procedure, for all children but maternal voice was played only to intervention group by another person to blind the researcher. Child’s cooperation for the entire procedure was recorded as video by researcher and later video was rated using FLACC behavioural scale. Pain perception was rated by children using Wong-Baker faces pain rating scale. The results showed a significant difference in the level of child’s cooperation with mean (SD) distress score of 7(2) in control group and 4.52(2.15) in the intervention group (p=0.0002). There was no significant difference in pain perception of control and intervention groups. Significant moderate positive correlation (0.31) was found in the child’s distress and pain perception levels (p=0.03). There was significant negative association of age was found with the child’s distress (-0.30) and pain perception level (-0.33) at (p=0.04, 0.02) respectively. In cconclusion, recorded maternal voice can significantly decrease the child’s distress level thus improve the child’s cooperation during bone marrow examination along with local anaesthesia. As the child’s cooperation increased, the child perceived less pain during the procedure. Older children were more cooperative and perceived less pain as compared to younger ones. Nurses are at an ideal position to implement this cost-effective, non-pharmacological intervention for children undergoing bone marrow examination.

Background: Bone Marrow Aspiration (BMA) and Bone Marrow Trephine Biopsy (BMB) are used to diagnose various hematological disorders. BMA is useful for study of cell cytology; material can also be used for ancillary tests like cytogenetics, flow cytometry, which improves the diagnostic utility. BMB allows complete assessment of marrow architecture along with pattern of distribution of abnormal infiltrates. Thus, BMA & BMB serve as complimentary procedures to diagnose various hematological disorders if performed simultaneously. Material and methods: Hospital based prospective study done within the duration of 2 years starting from August 2020 to August 2022. All the patients who underwent bone marrow examination at Department of Pathology, Tertiary Care Hospital of Ahmedabad, Gujarat, India were included. BMA was done using Salah needle under aseptic precautions from posterior superior iliac spine. 8-10 aspirate smears were prepared, stained by Romanowsky stains. BMB was also done in all cases using Jamshidi needle from same site. The biopsy was processed and slides were stained by Hematoxylin and Eosin (H&E). Evaluation was done by two pathologists. Results: Total 106 patients were included. Maximum number of patients belonged to 50-59 years age group followed by 60-69 years of age with M:F ratio of 1.6:1. Leading clinical feature was weakness/fatigue followed by pallor/anemia & fever. Megaloblastic Anemia (38%) was the most common hematological disorder in study population followed by Acute Leukemia (11%). 80% positive correlation between BMA & BMB was identified to diagnose various disorders. Conclusion: Megaloblastic anemia is the most common hematological disease in study population & can present with variable cytopenia. Accurate diagnosis depends on BMA & BMB evaluation along with peripheral smear & biochemical immunoassays. The role of BMA & BMB remains untouched in the diagnosis of various hematological disorders in-spite of newer methods like immunohistochemistry, flow cytometry, cytogenetics and molecular assays.

Background: Bone marrow (BM) examination is an important investigation for staging or primary diagnosis of malignant lymphomas. The frequency of BM infiltration by lymphoma is quite variable. There are limited data available from developing countries on the pattern of BM involvement in patients of non-Hodgkin’s lymphoma (NHL). The aim of this study was to see the pattern of BM involvement by B-Cell NHL from a Tertiary Care Hospital in North India. Materials and Methods: All cases of B-cell NHL with BM involvement were included in this study. Peripheral blood smear, BM aspiration, and biopsy were performed for diagnosis and staging in all patients. Results: A total of 43 patients were diagnosed as B-cell NHL on BM aspiration and biopsy. The median age of our patients was 54.26 ± 15.07 years with a male: female ratio of 2.9:1. Twenty-four were indolent B-cell NHL cases and 19 patients had aggressive B-cell NHL. Indolent lymphomas such as SLL/CLL, MCL, FL, and marginal zone lymphoma are more common compared to aggressive NHL such as DLBCL and Burkitt’s lymphoma. Indolent lymphoma was more common in females than males (37.5% vs. 10.5%). The classical B-symptoms were present in 32.6% (n = 14). The BM was hypercellular in 62.8% of cases (n = 27) and cellular in 14% (n = 6). The pattern of BM biopsy involvement was diffuse in 65.1% (n = 28), interstitial in 23.3% (n = 10), and nodular in 11.6% (n = 5). Diffuse involvement of marrow was more frequent than nodular in aggressive lymphomas compared to indolent ones. Conclusions: In patients with B-cell NHL, BM involvement is more common in the indolent disease. The pattern of diffuse marrow involvement is more common in our region.

Objectives VEXAS syndrome is an adult-onset autoinflammatory disease caused by a somatic pathogenic mutation in the UBA1 (ubiquitin-like modifier activating enzyme 1) gene. Patients present with rheumatologic manifestations and cytopenias and may have an increased predisposition to myelodysplastic syndrome (MDS) and plasma cell neoplasms. Prior studies have reported on the peripheral blood and bone marrow findings in patients with VEXAS syndrome. Due to the protean clinical presentation and lack of specificity of morphologic features (eg, vacuoles in early erythroid and granulocytic precursors), an optimal screening methodology to identify these patients in a timely fashion is desirable. Methods To further evaluate and describe the salient diagnostic morphologic features in VEXAS syndrome, we carried out a comprehensive study of the largest single-institution cohort to date. Diagnostic and follow-up bone marrow biopsy specimens from 52 male patients with molecularly identified VEXAS syndrome underwent central review. Results Cytopenias were common in all cases, primarily macrocytic anemia, monocytopenia, and thrombocytopenia. Bone marrow aspirate and biopsy were often hypercellular, with an increased myeloid/erythroid ratio, granulocytic hyperplasia with left shift, erythroid left shift, and megakaryocyte hyperplasia, which exhibited a range of striking morphologic findings. Distinctly vacuolated myeloid and erythroid precursors were seen in more than 95% of cases. Conclusions Our data reveal potential novel diagnostic features, such as a high incidence of monocytopenia and distinct patterns of atypical megakaryopoiesis, that appear different from dysmegakaryopoiesis typically associated with MDS. In our experience, those findings are suggestive of VEXAS, in the appropriate clinical context. [ABSTRACT FROM AUTHOR]

Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA). Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients. Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin

Virtual reality (VR) technology has received considerable interest in the healthcare field, particularly in pediatric oncology. The purpose of this study was to examine the existing and future applications of VR in reducing the discomfort associated with pediatric oncology procedures such as bone marrow biopsy, bone marrow aspirate, and lumbar puncture. A comprehensive search was conducted across numerous databases from 2005 to 2023, embracing several study designs to provide a strong evidence foundation. Using diversion and relaxation strategies, VR can help pediatric cancer patients cope with the emotional issues they confront during operations. VR has shown significant potential for lowering pain and anxiety during several pediatric medical procedures. Patient feedback focused on VR’s empowering and anxiety-reducing benefits, while healthcare staff reported increased patient participation and procedural efficiency. VR implementation challenges include the cost of specialized technology, the need for specific virtual settings, and the need for training healthcare workers. VR shows promise in improving the pediatric cancer experience, but more study and cooperation are required to realize its full potential.

Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA). Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients. Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin <10 g/dL, total leukocyte count <4000/mm3, and platelet count <100,000/mm3 were included in this study. The patient's posterior iliac crest was used for BMA. The Leishman stain was used to color BMA smears for microscopy. Results: This study comprised 51 cases of pancytopenia, with acute leukemia and megaloblastic anemia accounting for the majority (11 cases each out of 51), followed by dimorphic anemia (10/51), hypocellular marrow (9/51). The clinical symptom of generalized weakness and pallor was present in all instances (100%) and was followed by fatiguability (72%) and dyspnea (48%). The last two least frequent symptoms, lymphadenopathy, and hepatomegaly, were also present in many patients. A significant proportion of pancytopenia individuals experienced lymphadenopathy and hepatomegaly, which were the last two least prevalent appearances. Conclusion: In most cases, bone marrow aspiration in pancytopenia patients aids in determining the underlying reason. Understanding the illness process, planning future research, and managing cytopenia patients can all benefit from it. [ABSTRACT FROM AUTHOR]

Objectives Determination of bone marrow cellularity is a key part of bone marrow examination because it provides a small window into a patient's current state of hematopoietic well-being. Traditionally, bone marrow cellularity is estimated semiquantitatively through microscopic examination of core biopsy specimens harvested from the iliac crest of the pelvic bone. Bone marrow cellularity is then designated as hypercellular, normocellular, or hypocellular based on the patient's age. This assessment can have significant clinical impact, but the variation in the age-adjusted normocellularity range is not sufficiently characterized because of a lack of study data, especially in older patients (those older than 70 years of age). This study further established the normal range of bone marrow cellularity, particularly in older adults. Methods In this study, 570 benign staging and healthy donor bone marrows from patients 1 year to 93 years of age were analyzed for cellularity. Results Linear regression modeling demonstrates that cellularity in adults declines approximately 3% per decade, including after the seventh decade of life. The 90% reference interval for normocellularity in United States is 30% to 75% for those aged 18 to 90 years. Conclusions The findings revealed a more stable and slower rate of decline in cellularity with age in adults than the widely used linear model of "100% minus the patient age in decades." Normocellularity is better modeled based on age group. In those younger than 20 years of age, normocellularity ranges from 45% to 85% (mean [SD], 65% [20%]), as defined by Friebert et al in 1998. Based on our study finding of a little less than 3% decline per decade of age, the following is our recommendation for normocellularity range: For individuals 20 to 40 years of age, it ranges from 40% to 70% (mean [SD], 55% [15%]); for individuals 40 to 60 years of age, it ranges from 35% to 65% (mean [SD], 50% [15%]); and for individuals older than 60 years of age, it ranges from 30% to 60% (mean [SD], 45% [15%]). Interestingly, those older than 70 years of age do not show a significant decrease from those aged 60 to 69 years. [ABSTRACT FROM AUTHOR]

Background: Pancytopenia is a relatively common hematological entity suggestive of many serious and life threatening illness ranging from simple viral infections to megaloblastic anemia. Drug induceed bone marrow hypoplasia to fatal aplasia and terminal phase of leukemias. The severity of pancytopenia determines management and prognosis sometimes cause cannot be determined. Aim & objectives: To evaluate various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia of adult group. Material and Methods: Fifty patients with a hematological diagnosis of pancytopenia were studied during the period august 2020 to august 2022, in the Department of Pathology, SVS Medical College and Hospital, Mahabubnagar. Results: Out of 50 cases, 34 were males and 16 were females. Most of the patients were in the age group of 41-60 years (54%). Megaloblastic anemia was the most important cause of pancytopenia. Conclusion: This study concluded that most common causes of pancytopenia is megaloblastic anemia followed by aplastic anaemia, hypersplenism and leukaemia. Nutritional anaemia is commonest cause for pancytopenia. This may be due to megaloblastic anaemia or deficiency of iron/vitamin B12/folate combined. Rare causes were infections, myeloproliferative disease and SLE. Bone marrow examination is a single useful investigation which reveals the underlying causes in patients with pancytopenia. [ABSTRACT FROM AUTHOR]

Background: Lymphoma is a common malignant proliferative disease in which bone marrow infiltration will upstage the disease and thus affect prognosis of the disease. As of now bone marrow biopsy is considered as a reference standard to find out bone marrow involvement in lymphoma. Performing an invasive and painful intervention in all newly diagnosed lymphoma patients is controversial. PET-CT is a non-invasive technique that gives functional information about the cells using the glucose metabolism. It can detect early bone marrow and extra medullary organ involvement which can lead to restaging of the disease. These advantages make PET-CT a valuable adjunct in diagnosis of lymphoma. Aims and Objectives: Our study aims to evaluate the usefulness of 18 F-FDG PET-CT, a non-invasive, semi quantitative whole body imaging technique for detection of early bone marrow and extra medullary organ involvement in lymphoma patients which in turn can obviate the need for bone marrow study (BMS). The primary objective of study is to categorise FDG uptake in bone marrow as diffuse /unifocal /multifocal / no uptake and to correlate pattern of FDG uptake to bone marrow study. Our study also assesses the role of FDG PET/CT in staging of lymphoma. Materials and Methods: Thirty patients with newly diagnosed lymphoma in the age group 18 to 75 years of both sexes within 3 months of diagnosis and who have not been started on any treatment was included in the study. Marrow uptake on FDG PET/CT has been categorized as diffuse, unifocal, multifocal and no uptake. Agreement between bone marrow study and FDG PET/CT has been assessed by reliability analysis using Cohen’s kappa. Sensitivity, specificity, PPV, NPV of PET/CT in detecting marrow involvement have been calculated. Results: The sensitivity, specificity, PPV, NPV and accuracy of 18 F-FDG PET-CT in detecting marrow involvement of lymphoma cases are 86.6%, 77.7%, 68.4%, 91.3% and 80.9% respectively. 18 F-FDG PET-CT detected bone marrow involvement in 86.6% (13 out of 15 total positive cases) cases of lymphoma which included both HL and NHL. Reliability analysis using Cohen’s kappa is used to test the agreement between bone marrow study and 18F-FDG PET/CT. k value of 0.6 was obtained which showed a moderate agreement between bone marrow study and 18F-FDG PET/CT in marrow assessment. Conclusion: 18F‐FDG PET/CT is a highly sensitive imaging modality which can pick up extra‐nodal organ and BMI in patients with lymphoma and can upstage the disease and alter treatment strategies. PET‐CT cannot completely replace the bone marrow study. However, being an invasive painful procedure, BMB can be avoided in cases with unifocal or multifocal marrow involvement on PET‐CT. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) technology has received considerable interest in the healthcare field, particularly in pediatric oncology. The purpose of this study was to examine the existing and future applications of VR in reducing the discomfort associated with pediatric oncology procedures such as bone marrow biopsy, bone marrow aspirate, and lumbar puncture. A comprehensive search was conducted across numerous databases from 2005 to 2023, embracing several study designs to provide a strong evidence foundation. Using diversion and relaxation strategies, VR can help pediatric cancer patients cope with the emotional issues they confront during operations. VR has shown significant potential for lowering pain and anxiety during several pediatric medical procedures. Patient feedback focused on VR's empowering and anxiety-reducing benefits, while healthcare staff reported increased patient participation and procedural efficiency. VR implementation challenges include the cost of specialized technology, the need for specific virtual settings, and the need for training healthcare workers. VR shows promise in improving the pediatric cancer experience, but more study and cooperation are required to realize its full potential. [ABSTRACT FROM AUTHOR]

Introduction: Pancytopenia, simultaneous presence of anemia, leucopenia and thrombocytopenia, is a common clinical entity that we see in day to day practice Proper diagnostic evaluation requires detailed clinical history, physical examination and haematological assessment including careful peripheral blood smear examination and bone marrow evaluation. Materials and Methods: A total of 80 adult patients with pancytopenia/bicytopenia presenting between January 2021 to January 2022 were included in the study. All patients underwent detailed clinical history and physical examination. Careful peripheral blood smear examination, CBC and bone marrow aspirate was done in all. Bone marrow biopsy was done wherever feasible. Results: Megaloblastic anemia was the commonest cause of pancytopenia/bicytopenia making up 37.5% of all cases followed by erythroid hyperplasia (20%), aplastic anemia (10%). Haematological malignancies accounted for 23.75% cases of the total. Bone marrow biopsy aided in the diagnosis of 8 cases (6 cases of aplastic anemia and two cases of dry tap) while in others it was concordant with aspiration findings. Conclusion: Bone marrow aspiration and biopsy are an important adjunct to peripheral smear examination for evaluation of cytopenias. Bone marrow trephine biopsy is helpful in cases of dry tap. We also conclude that there is high prevalence of megaloblastic anemia due to nutritional deficiency among young population. Hence, this age range should be the prime target for education regarding proper dietary habits, the remediation of which might reduce the clinical burden of megaloblastic anemia. [ABSTRACT FROM AUTHOR]

Bone marrow, a soft spongy tissue, is containing mesenchymal stem cells, that are well-recognized according to their self-renewability and stemness. Therefore, we hypothesized that bone marrow aspirate concentrate (BMAC) could have a pivotal influence on the process of wound healing in particular when it is combined with platelet-rich plasma (PRP). Thirty-six albino mice (BALB/c) were used in the study and they were grouped as negative-control, PRP treated, BMAC treated and BMAC plus PRP treated. An incisional wound (1 cm2) was made at the back of mouse and their wounds were treated according to their treatment plan and group allocations. Later, the skin at the treated wound sites was collected on days 7, 14, and 21 for histopathological investigation. The results showed that there was a statistically significant difference in BMAC+PRP-treated wounds over the rest of the treated groups in the acceleration of wound healing throughout the experiment by increasing the rate of wound contraction, re-epithelization process, and granulation tissue intensity with fluctuated infiltration in the number of the neutrophils, macrophages, and lymphocytes, also restoration of the epidermal and dermal thickness with less scarring and hair follicle regeneration vs to the negative-control, PRP and BMAC only treated groups. Our findings indicated that BMAC containing mesenchymal stem cells is an efficient approach, which can be used to enhance a smooth and physiopathological healing process, especially when it is used in combination with PRP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Platelets play vital roles in repair of the minute vascular damages in day to day life, wound repair, the innate immune response and metastatic tumour cell biology. AIMS AND OBJECTIVES: The aim of our study was to examine bone marrow aspiration smears for changes in megakaryocytes in patients with thrombocytopenia. MATERIALS AND METHODS: It was a prospective study carried out from June 2022 to June 2023. A series of 53 bone marrow aspirates were examined in patients with thrombocytopenia to look for changes in megakaryocytes. RESULTS: Out of the 53 cases megakaryocytes were suppressed in 20 cases (37%), inadequate in 9 cases (17%), hypoactive in 11 cases (21%), absent in 6 cases (11.5%) and adequate in 7 cases (13.5%) of thrombocytopenia. In our study nutritional deficiency was the most common cause of thrombocytopenia. CONCLUSION: Peripheral blood and bone marrow examination is crucial for patients with thrombocytopenia. Understanding the morphological changes of megakaryocytes in bone marrow aspirates can improve the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

This double-blinded randomized controlled trial included 46 children between 4 to 12 years of age with haematological malignancy, scheduled for bone marrow examination at tertiary care hospital of India. Subjects were enrolled into two groups (23 each) by stratified random sampling based on the type of procedure scheduled to them. The maternal voice was recorded for 3 minutes before the procedure and headphones was placed during the procedure, for all children but maternal voice was played only to intervention group by another person to blind the researcher. Child’s cooperation for the entire procedure was recorded as video by researcher and later video was rated using FLACC behavioural scale. Pain perception was rated by children using Wong-Baker faces pain rating scale. The results showed a significant difference in the level of child’s cooperation with mean (SD) distress score of 7(2) in control group and 4.52(2.15) in the intervention group (p=0.0002). There was no significant difference in pain perception of control and intervention groups. Significant moderate positive correlation (0.31) was found in the child’s distress and pain perception levels (p=0.03). There was significant negative association of age was found with the child’s distress (-0.30) and pain perception level (-0.33) at (p=0.04, 0.02) respectively. In cconclusion, recorded maternal voice can significantly decrease the child’s distress level thus improve the child’s cooperation during bone marrow examination along with local anaesthesia. As the child’s cooperation increased, the child perceived less pain during the procedure. Older children were more cooperative and perceived less pain as compared to younger ones. Nurses are at an ideal position to implement this cost-effective, non-pharmacological intervention for children undergoing bone marrow examination.

Background Hematological conditions like pancytopenia are widespread in our lab. Diagnosis and therapy of pancytopenia require etiology analysis. Most pancytopenia causes are determined by the Absolute Reticulocyte Count (ARC), which has been neglected. The aim of this study is to determine the importance of the Absolute Reticulocyte Count (ARC) in assessing the etiology of pancytopenia, with a focus on its role in distinguishing between different causes of this hematological condition. Materials and Methods The study was conducted in a tertiary health care institution in Bihar, India. Over the course of 1 year (April 2021 to March 2022), a descriptive cross-sectional study was carried out. Complete blood counts (CBC), reticulocyte count including ARC and peripheral blood smear (PBS) examination were performed in all cases of pancytopenia. Serum ferritin, Serum vitamin B12 level and serum folate were also estimated. Bone marrow examination was done in all cases. Results A total of 200 pancytopenia cases were assessed, and the findings were recorded. In cases of aplastic anemia, ARC was found to be 100x109 /L was seen in neoplastic disorders. Lower ARC values were associated with conditions like aplastic anemia, while higher ARC values were indicative of acute leukemia and metastatic deposits, making ARC a valuable diagnostic tool. Conclusion It was concluded that ARC is crucial in distinguishing between different causes of pancytopenia, and it must be a regular part of work-up to prevent needless invasive bone marrow examinations in cases of pancytopenia. Recommendation This study suggests that pancytopenia patients be routinely assessed with Absolute Reticulocyte Count (ARC). ARC helps identify pancytopenia etiologies, preventing needless bone marrow exams. Pancytopenia diagnosis and treatment can be improved by adding ARC to diagnostic techniques.

Background:Hematological disorders are quite frequent in all age groups. Bone marrow aspiration is a relatively safe procedure done for the diagnosis and management of hematological disorders. Aims and Objectives: The present study aimed to evaluate the spectrum of various hematological disorders diagnosed on bone marrow aspiration. Material and Methods: It was a one year observational study conducted in the hematology section of Department of Pathology, Govt. Medical College, Jammu. Bone marrow aspirations were performed, smears were prepared, stained with Giemsa stain and examined under microscope. Bone marrow findings were noted. Results: Of 323 cases, 166 (51%) were males and 157 (49%) were females. Mean age was 37.9 years with range of 5 months to 85 years. Various disorders seen were megaloblastic anemia (89,27.5%), dual deficiency anemia (27,8.4%), erythroid hyperplasia (50,15.5%), hypoplastic marrow (11,3.4%), acute leukemia (46,14.2%), chronic lymphoproliferative disorder (13, 4.0%), chronic myeloid leukemia (21, 6.5%), ITP (14, 4.3%), myelodysplastic syndrome (4,1.2%), plasma cell dyscrasia (9,2.8%), leishmaniasis (1,0.3%), metastatic malignancy (1,0.3%). Megaloblastic anemia was the most common bone marrow diagnosis. Acute leukemia was the most frequently diagnosed hematological malignancy. Conclusion: Bone marrow aspiration remains an important tool in the diagnosis of wide range of hematological disorders. [ABSTRACT FROM AUTHOR]

Objective: To evaluate etiological spectrum of pancytopenia in adults using bone marrow aspiration biopsy. Study Design: Randomized Prospective study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2018-October 2020. Material & Methods: Eight hundred bone marrow biopsies were performed out of which 250 patients came with pancytopenia. 135 patients out of these were in adult age group which are included in this study. Results: Out of 250 patients adults were 135 that presented with pancytopenia. Male to female ratio came out to be 1.22:1. The most common disorder that results in pancytopenia came out to be megaloblastic anemia that was 29.6%, after that 26.6% were infection related changes, 10.3% aplasia, 9.6% reactive marrow, 5.9% acute leukemia, 3.7% chronic leukemia and iron deficiency anemia followed by 2.9% myelodysplastic syndromes and hypersplenism, 2.2% multiple myeloma, 1.4% mixed deficiency anemia and 0.74% myelofibrosis. We also analyzed patients on their presenting complaints as well. Most common complaint of presentation was fever (54.8%), (31.85%) with fatigue and malaise, (31.1%) pallor, vomiting and diarrhea (25.9%) followed by bleeding (14.8%). On clinical examination 12% cases presented with hepatomegaly and 16.6% with splenomegaly. Conclusion: Pancytopenia is a common hematological finding in our setup with megaloblastic anemia to be the most common cause of it. Therefore, it's very important to diagnose it as this is a curable (reversible) deficiency and patients can easily be managed to prevent serious hematological and neurological abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: A bone marrow examination involves the pathological analysis of samples from the bone marrow, which are obtained through bone marrow aspiration (BMA) and biopsy procedures. This examination is employed for the diagnosis of various hematological and nonhematological conditions. Both aspirate and biopsy samples are essential, offering a comprehensive bone marrow assessment. Objectives: In this study, we aim to compare the simultaneous evaluation of bone marrow aspirates and biopsies and to study diagnostic accuracy and concordance rate. Materials and Methods: This research was performed at the Department of Pathology, Shri Aurobindo Medical College, and Postgraduate Institute in Indore, Madhya Pradesh, India. The study was conducted from January 2019 to December 2019 and evaluated 200 patients. In 170 instances, bone marrow biopsy (BMB) and BMA procedures were conducted simultaneously, with 14 cases excluded due to issues like hemodilution or inadequate samples. Microscopic examinations were carried out on both aspirate slides and trephine biopsy sections, with the findings meticulously documented. Results: In the present research, the most prevalent clinical reason for performing a bone marrow examination was anemia (28.2%), closely followed by acute leukemias (21.9%). Among the 156 cases examined, BMA and biopsy led to a definitive diagnosis in 116 patients (74.3%), while biopsy alone diagnosed 27 cases (17.3%). Conclusion: While BMB continues to be the established benchmark for bone marrow analysis due to its heightened reliability and sensitivity, the combined use of both BMA and BMB enhances diagnostic yield significantly.

Background: Hematological disorders are quite frequent in all age groups. Bone marrow aspiration is a relatively safe procedure done for the diagnosis and management of hematological disorders. Aims and Objectives: The present study aimed to evaluate the spectrum of various hematological disorders diagnosed on bone marrow aspiration. Material and Methods: It was a one-year observational study conducted in the hematology section of Department of Pathology, Govt. Medical College, Jammu. Bone marrow aspirations were performed, smears were prepared, stained with Giemsa stain and examined under microscope. Bone marrow findings were noted. Results: Of 323 cases, 166 (51%) were males and 157 (49%) were females. Mean age was 37.9 years with range of 5 months to 85 years. Various disorders seen were megaloblastic anemia (89,27.5%), dual deficiency anemia (27,8.4%), erythroid hyperplasia (50,15.5%), hypoplastic marrow (11,3.4%), acute leukemia (46,14.2%), chronic lymphoproliferative disorder (13, 4.0%), chronic myeloid leukemia (21, 6.5%), ITP (14, 4.3%), myelodysplastic syndrome (4,1.2%), plasma cell dyscrasia (9,2.8%), leishmaniasis (1,0.3%), metastatic malignancy (1,0.3%). Megaloblastic anemia was the most common bone marrow diagnosis. Acute leukemia was the most frequently diagnosed hematological malignancy. Conclusion: Bone marrow aspiration remains an important tool in the diagnosis of wide range of hematological disorders.

We performed a retrospective single-center analysis to investigate the diagnostic yield of bone marrow puncture in patients with liver cirrhosis and cytopenia. Liver cirrhosis patients receiving bone marrow aspiration or biopsy for the diagnostic work-up of otherwise unexplained peripheral blood cytopenia at our institution between 2004 and 2020 were enrolled in this study. We evaluated findings from cytologic, histologic and immunologic assessment and final diagnostic outcomes. A total of 118 patients with a median age of 55 years and a median Child–Pugh score of B (8 points) were enrolled. The main etiologies of liver cirrhosis were viral hepatitis (B and C) or chronic alcohol consumption. The majority of patients (60%) exhibited concurrent anemia, leukocytopenia and thrombocytopenia. Bone marrow assessment revealed normal, unspecific or reactive alterations in 117 out of 118 patients (99%). One patient was diagnosed with myelodysplastic syndrome. Our findings suggest that peripheral blood cytopenia in patients with liver cirrhosis is rarely associated with a primary bone marrow pathology. [ABSTRACT FROM AUTHOR]

Histoplasmosis is an endemic infection caused by Histoplasma capsulatum, leading to a broad spectrum of disease from asymptomatic to severe disseminated disease. To diagnose Histoplasmosis, culture remains the gold standard for the laboratory diagnosis; however, this fungus grows slowly, taking a long time 2 to 3 weeks or may take up to 8 weeks. Therefore, some other methods such as bone marrow examination play an essential role in rapid identification and early diagnosis, especially in cases of severe disseminated disease. In this case, we report a 55-year-old man with a 1-year history of gout, self-medicating (including Medrol) who was admitted to the hospital because of persistent fever and swelling of his left arm. About laboratory investigation, there was a bicytopenia (RBC and PLT), blood and pus cultures many times were negative. On the slide of the bone marrow specimen, images of yeast suspected of Histoplasma capsulatum were observed. Therefore, the patient was treated with antifungal medication, and the culture was repeated with prolonged follow-up time and positive results with H. capsulatum after 16 days. In conclusion, bone marrow test plays a significant role in the diagnosis of some fungal infections, which can contribute to an early diagnosis, especially in cases of culture and serological tests are not available or cannot be performed. Patients who present with fever and bicytopenia or pancytopenia should be performed early bone marrow test, which can support the earlier diagnosis to have appropriate treatment. [ABSTRACT FROM AUTHOR]

Histoplasmosis is an endemic infection caused by Histoplasma capsulatum, leading to a broad spectrum of disease from asymptomatic to severe disseminated disease. To diagnose Histoplasmosis, culture remains the gold standard for the laboratory diagnosis; however, this fungus grows slowly, taking a long time 2 to 3 weeks or may take up to 8 weeks. Therefore, some other methods such as bone marrow examination play an essential role in rapid identification and early diagnosis, especially in cases of severe disseminated disease. In this case, we report a 55-year-old man with a 1-year history of gout, self-medicating (including Medrol) who was admitted to the hospital because of persistent fever and swelling of his left arm. About laboratory investigation, there was a bicytopenia (RBC and PLT), blood and pus cultures many times were negative. On the slide of the bone marrow specimen, images of yeast suspected of Histoplasma capsulatum were observed. Therefore, the patient was treated with antifungal medication, and the culture was repeated with prolonged follow-up time and positive results with H. capsulatum after 16 days. In conclusion, bone marrow test plays a significant role in the diagnosis of some fungal infections, which can contribute to an early diagnosis, especially in cases of culture and serological tests are not available or cannot be performed. Patients who present with fever and bicytopenia or pancytopenia should be performed early bone marrow test, which can support the earlier diagnosis to have appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: The most typical cause of thrombocytopenia is immune-mediated thrombocytopenic purpura (ITP). Thrombocytopenia can cause insufficient clot formation and increase the risk of bleeding. Bone marrow aspiration is commonly used for this purpose. ITP was primarily caused by immune-mediated platelet destruction and a megakaryocyte maturation abnormality. The objectives of this study were to evaluate the inter-observer reliability of bone marrow examinations and to identify different megakaryocyte morphological characteristics observed in ITP bone marrow aspiration smears., Materials and Methods: A prospective study was done on 100 cases of bone marrow aspirations of thrombocytopenia in 1 year from 2019 to 2020 in Central India's tertiary care center. Reporting was done by hematopathologists with particular emphasis on megakaryocyte morphology., Results: A total of 100 cases of bone marrow aspiration were done in one year of thrombocytopenia, out of which 35 (35%) cases were of primary immune thrombocytopenia in which morphological alterations were noted, which constitutes the second most common cause of bone marrow aspiration. In contrast, acute leukemia was the first leading cause. As long as a thorough history and physical examination are conducted, a complete blood count, a peripheral blood smear, and routine coagulation studies reveal no abnormalities other than thrombocytopenia, the literature suggests that performing a routine bone marrow examination to diagnose ITP is unnecessary. Although ITP bone marrow smears showed morphological changes in megakaryocytes, they can be significant as well as insignificant in view of classifying it as myelodysplastic syndrome (MDS)., Conclusion: This study indicates significant abnormalities in the megakaryocytes of ITP patients. Understanding the morphological changes of megakaryocytes in bone marrow aspirates is equally important in the era of molecular diagnostics. It can enhance the accuracy of diagnosis for a variety of hematological disorders and enable the implementation of suitable treatment measures., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. 637/MC/IEC/2020 issued approval 637/MC/IEC/2020, 04/01/2020. STUDY WAS APPROVED BY COMMITTEE. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Verma et al.)

Background: Exudative pleural effusion in children is mainly caused by bacterial infections. Here, we present a 2.5-years-old boy with acute fever, unilateral pleural effusion, and poor response to the insertion of chest tube. Case description: The patient was admitted to the Taleghani Hospital of Gorgan (northeast of Iran) with complaint of fever starting from a week ago. The patient was treated with intravenous (IV) antibiotics and a chest tube was inserted. Considering the poor response to this treatment and leukocytosis, further assessments were made. Microbial examination of pleural fluid and SARS-CoV-2 test of nasopharyngeal swab were negative. Pleural biopsy and bone marrow aspiration analysis by flow cytometry revealed T-cell-acute lymphoid/lymphoblastic leukemia (ALL). The patient was referred to the oncology ward and chemotherapy was performed. After four weeks, he started to develop symptoms of respiratory distress, fever, and melena. The next SARS-CoV-2 test on throat swab was suspicious. Chest CT scan showed centrilobular ground glass opacity and peribronchial wall thickening in both lungs in favor of COVID-19. Treatment started with hydroxychloroquine, cotrimaxazole, meropenem, vancomycin, and pantoprazole. The patient was transferred to the PICU because of respiratory distress and decreased O2 saturation. Four days later, repeated test on nasopharyngeal swab was positive for COVID-19. Unfortunately, the patient did not respond to treatment and passed away a few days later. Conclusion: T-cell ALL is an aggressive type of leukemia with poor response to treatment, and plural effusion is a rare presentation of malignancy in children. Our patient's condition was unfortunately complicated with COVID-19 involvement and he passed away before we see the effect of treatment on ALL.

Introduction: Evaluation of non neoplastic and neoplastic haematological disorders require bone marrow examination which is an important diagnostic tool. This includes Bone Marrow Aspiration (BMA) and Bone Marrow Biopsy (BMB). Subtyping of Acute Leukaemia (AL) requires flow cytometry immunophenotyping and Real Time Polymerase Chain Reaction (RT-PCR), which helps in identifying cell antigens and genetic abnormalities, respectively. This is helpful to guide specific treatment for patients. Aim: To evaluate the clinical profile, cytological and histological pattern of various haematological disorders using bone marrow examination and to determine immunophenotypes using ancillary techniques in patients with AL. Materials and Methods: This was a cross-sectional observational study conducted in Department of Pathology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu, India. Data was collected for a period of two years from May 2020 to April 2022. A total of 62 cases were included. Clinical details and bone marrow examination findings were noted for all BMA and BMB cases that satisfied the inclusion criteria and flow cytometry along with RT-PCR diagnosis was done for suspected AL cases. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the 62 cases studied, age of patients ranged from 32 to 81 years. Majority of them were in the 5th to 6th decade. Females 32 (51.6%) were more commonly affected. Pancytopenia 15 (24.2%) was the most common clinical presentation. Total 49 (79%) were diagnosed with BMA and 61 (98.4%) were diagnosed with BMB. Megaloblastic anaemia 16 (25.8%) and acute myeloid leukaemias 6 (9.6%) were the most common cause of benign haematological disorder and haematological malignancy respectively. The RT-PCR test for Break point Cluster-Abelson Tyrosine Kinase (BCR-ABL) and Promyelocytic Leukaemia-Retinoic Acid Receptor Alpha (PML- RARA) fusion gene analysis showed association in patients with Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) respectively. Conclusion: Biopsy, being gold standard, provides details about the pattern, extent of tumour, metastatic deposit and granulomatous pathology, but BMA also proved better for study of the cell. Flow cytometry and RT-PCR were effective tools that enable the identification of immunophenotype in AL as well as to assess treatment progress and predict prognosis.

In this issue, a nationwide retrospective Japanese study finds that, in a second opinion setting, one‐third of bone marrow aspirates from patients suspected of myelodysplastic syndromes are heavily haemodiluted. Moreover, in four‐fifths of such cases, the failure to obtain the correct material for diagnosis went undetected by the referring institution. These data are intriguing, but given their special set‐up, caution should be exerted in transposing them to other countries. Commentary on: Ogata et al. Prevalence of massively diluted bone marrow cell samples aspirated from patients with myelodysplastic syndromes (MDS) or suspected MDS: A retrospective analysis of nationwide samples in Japan. Br J Haematol 2024;204:1856‐1861. [ABSTRACT FROM AUTHOR]

Background: Bone marrow aspiration (BMA) is a medical procedure necessary to the diagnosis and monitoring of patients with hematological or nonhematological disorders. This procedure is considered painful, and patients are generally anxious before and during BMA. Objective: This study assesses the effect of immersive virtual reality on pain during BMA. Methods: This observational prospective and monocentric study enrolled 105 consecutive patients who underwent sternal BMA with lidocaine anesthesia. The study was carried on during 2 periods. First, virtual reality facemask (VRF) was proposed to all patients in the absence of exclusion criteria. During the second period, BMA was performed without the VRF. For all patients, pain intensity after the procedure was assessed using a 10-point numerical pain rating scale (NPRS). All analyses were performed on propensity score--matched cohort (with or without VRF) to evaluate efficacy on NRPS levels. Results: The final matched cohort included 12 patients in the VRF group and 24 in the control group. No difference in anxiety level before BMA evaluated by the patient and by the operator was observed between groups (P=.71 and .42 respectively). No difference of NPRS was observed using VRF when compared to control group (median NPRS 3.8, IQR 2.0-6.3 vs 3.0, IQR 1.9-3.0, respectively; P=.09). Conclusions: Our study did not prove the efficacy of VRF to reduce pain during BMA. [ABSTRACT FROM AUTHOR]

The optimal follow-up care for relapse detection in acute myeloid leukemia (AML) patients in first remission after consolidation therapy with intensive chemotherapy is not established. In this retrospective study, we evaluate the diagnostic value of an intensive relapse surveillance strategy by regular bone marrow aspirations (BMA) in these patients. We identified 86 patients with newly diagnosed non-promyelocytic AML who had reached complete remission (CR) after intensive induction and consolidation chemotherapy between 2007 and 2019. Annual relapse rates were 40%, 17%, and 2% in years 1–3, respectively. Patients in CR were surveilled by BMA scheduled every 3 months for 2 years, followed by BMA every 6 months. This surveillance regimen detected 29 of 55 relapses (53%), 11 of which were molecular relapses (20%). The remaining 26 of 55 relapses (47%) were diagnosed by non-surveillance BMA prompted by specific suspicion of relapse. Most patients showed concurrent morphological abnormalities in peripheral blood (PB) at time of relapse. Seven percent of all morphological relapses occurred without simultaneous PB abnormalities and would have been delayed without surveillance BMA. Intensified monthly PB assessment paired with BMA every 3 months during the first 2 years may be a highly sensitive relapse surveillance strategy. [ABSTRACT FROM AUTHOR]

Introduction: Bone marrow aspirate concentrate (BMAC) use has increased for both primary treatment and as a surgical adjunct of several other musculoskeletal conditions such as degenerative joint disease and rotator cuff tears. Bone marrow harvest, when performed as part of musculoskeletal treatment or in conjunction with orthopedic surgery is commonly performed at the anterior iliac crest. No technique for ultrasound guidance has been validated at the anterior iliac crest. Objectives: Here we describe a novel approach for bone marrow aspiration at the anterior iliac crest utilizing ultrasound guidance to facilitate safe needle placement using a human cadaveric model. Methods: Using cadaver hemipelvises, needle placements were attempted along the anterior iliac crest via ultrasound guidance and latex dye was used to mark the site of cortical penetration. Results: A total of 39 cortical penetrations were attempted on 8 iliac crests. Needle placements were accurately placed on the crest under ultrasound guidance as confirmed by dissection of the relevant anatomy and confirmation of colored dye within the cortical penetration. Conclusion: Ultrasound can be used as a valuable tool for image guidance during bone marrow needle placement along the anterior iliac crest. This technique for initial needle placement at the anterior iliac crest is safe and feasible for providers with skill in ultrasound guided needle placement to assist with localization along safe zones for quality bone marrow cellular harvest.

Leukemia cutis is a comprehensive terminology for dermal manifestations of any type of leukemia either with accompanied or antecedent blood or bone marrow involvement. Although both myeloid and lymphoid neoplastic leukocytes can infiltrate the skin, the frequency is higher among children with congenital myeloid leukemia. However, the underlying pathogenesis of dermal tropism is not yet established. Clinical manifestation varies regarding appearance, site, and numbers. Skin biopsy is essential for the early establishment of the diagnosis and to guide for further testing and categorical management. We report the case of acute myeloid leukemia-cutis in a 22-year-old female where cutaneous manifestation preceded the hematological diagnosis of systemic leukemia. [ABSTRACT FROM AUTHOR]

Backgrond: Hemophagocytosis (HS) is an interesting finding that is observed in bone marrow, lymph nodes, CSF other reticuloendothelial systems but at times is overlooked or is not incorporated in reports. Demonstration of hemophagocytosis is one criterion in the diagnosis of Hemophagocytic Lymphohistiocytosis (HLH). Aims and Objective: Hemophagocytosis as an important finding evaluated in pediatric bone marrows having different clinical diagnosis. Materials and Methods: A retrospective descriptive analysis of bone marrow aspirates of 73 patients showing any degree of hemophagocytosis [out of 440 bone marrow aspirates] retrieved from the archives of Department of Pathology during the period from May 2017 to May 2020 were included in the study. Only those cases where microscopic examination revealed hemophagocytosis(73 cases) were included in the study. Results: On analysing the data of 73 bone marrow aspirate 11 (1 Primary,10 secondary) cases were confirmed clinicopathologically as Hemophagocytic lymphohistiocytosis, 9 cases (2 metastasis, 4 infective, 1 acute leukemia, ,1 nutritional deficiency and 1 Hypocellular marrow with degenerative changes) were not suspected to have HLH clinically however showed features of increased serum ferritin >500mg/dl and bone marrow aspirate hemophagocytosis, favouring a diagnosis of secondary HLH (WHO 2004). Conclusion: We present a spectrum of differential diagnosis presenting with hemophagocytosis in pediatric population and its clinico-biochemical correlation assessing progression to HLH.

Context: Pancytopenia is defined by reduction of all the three formed elements of blood below the normal reference. Hematological investigation forms the bedrock in the management of patients with pancytopenia and therefore needs detailed study. The aim of this study was to identify the underlying etiologies of pancytopenia cases presenting at our institute with clinico-hematological evaluation. Materials and Methods: In this 2-year prospective study, 105 patients aged ≥15 years admitted in hospital with a hematological diagnosis of pancytopenia followed by bone marrow aspiration and/or biopsy after receiving an informed consent were studied. The criteria applied for pancytopenia were hemoglobin level:

INTRODUCTION: Bone marrow aspiration (BMA) has an important role in the investigation and diagnosis of hematologic as well as nonhematologic malignancies and various other diseases. The procedure varies from one setting and person to the other. AIMS: The aim of the study is to study the role of 18G lumbar puncture (LP) needle in the diagnosis of bone marrow involvement in hematologic malignancies and metastasis for certain solid tumors. MATERIALS AND METHODS: During this hospital-based retrospective study, 708 patients who clinically and histopathologically diagnosed with the malignant lesion and subsequently undergone BMA were included in this study. RESULTS: BMA was done in 607 patients diagnosed with hematologic malignancies and 101 patients diagnosed with nonhematologic malignancies. Adequate marrow material was obtained in the first attempt in 683 (96.5%) cases. Multiple aspirations were needed in 25 (3.5%) cases. The majority (86.3%) of the patients experienced less pain by the 18 G LP needle compared to their previous experience with the conventional BMA needle. Needle breakage was not seen in any of the cases. CONCLUSION: The results of this study suggest that the 18G LP needle can be easily adopted for BMA and could be a great help in significantly reducing pain and complications in patients undergoing BMA.

Advanced diagnostic technologies such as ultrasound and computed tomography (CT) could not provide any information about the sternebrae cortex thickness and medullary cavity dimensions. Herein, we aim to provide relevant anatomy of the sternum and more sophisticated measurements to ensure safe needle insertion during bone marrow aspiration in dogs. This study revealed that the space between skin and cortex measures an average of 0.8 cm, which increases towards the xiphoid, as shown by ultrasound. Meanwhile, the sagittal section of the sternum showed that the cortex measured as thin as one millimeter. The medullary space of sternebrae 2nd – 7th was 1.5 cm², while the manubrium measured 3.8 cm². In conclusion, knowing the exact sternebrae dimensions helped the students to master the bone marrow aspiration technique and become sensitive to needle advancement once it reaches the cortex. [ABSTRACT FROM AUTHOR]

Background &Objective: Early diagnosis can be made based on the morphological examination of bone marrow aspiration (BMA) until the bone marrow biopsy (BMB) result is reported. This allows for treatment to be started immediately, especially in hematological malignancies for which urgent treatment is indicated. This study aimed to determine the sensitivity and importance of bone marrow aspiration in the diagnosis of hematological malignancies. Methods: In this study, the data of patients who underwent bone marrow aspiration and bone marrow biopsy in Van Yuzuncu Yil University hospital between 2017 and 2019 were retrospectively analyzed. A total of 500 patients who simultaneously underwent BMA and BMB were included in the study. Data were obtained from electronic medical records. Results: Indication for bone marrow evaluation was abnormalities in complete blood count in 270 (54%) of patients. The diagnosis was made based on the evaluation of BMA in 475 (95%). In 456 (96%) of the 475 patients diagnosed with BMA, the diagnosis was consistent with that of BMB. Agreement of BMB with BMA was 100% in acute and chronic leukemias, while BMA was not sufficient for the diagnosis of lymphoma and solid organ metastasis. Conclusion: Our study showed that the evaluation of BMA was highly sensitive in the diagnosis of hematological malignancies, such as acute leukemias, chronic leukemias, and multiple myeloma. [ABSTRACT FROM AUTHOR]

Introduction: Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Bone marrow aspirates along with their peripheral smears and bone marrow trephine biopsies are considered to be complementary. Materials and Methods: This hospital-based, cross-sectional study was carried out in the Department of Pathology for one year (March 2011 to March 2012) at BPKIHS, Dharan. Fortyeight adequate bone marrow aspirates along with peripheral blood smears and trephine biopsies were selected and examined. Bone marrow trephine biopsies performed simultaneously with aspirate were correlated with the other two fi ndings to arrive at a conclusive diagnosis. Results: Bone marrow aspiration and trephine biopsy were found as complementary tests in 51.8% of cases. Bone marrow trephine biopsy provided a conclusive diagnosis in 25.9% of cases where bone marrow aspiration was inconclusive. Bone marrow aspiration alone was diagnostic in 22.2% of cases. In 43.7% of cases both aspiration and trephine biopsy were unable to provide a specificdiagnosis. Bone marrow biopsy was the diagnostic investigation in cases like aplastic anemia, myelofi brosis, and hypoplastic marrow. Conclusions: This study concludes that bone marrow aspiration smear along with peripheral smear findings and marrow trephine biopsy is required to arrive at a conclusive result.

Priapism is defined as a whole or partial penile erection that persists for more than 4 hours without stimulation. Hematologic disorders are a significant risk factor for ischemic priapism. Here, we report a case of priapism due to chronic myelocytic leukemia. This is rare considering that the epidemiology of priapism in hematologic malignancies includes only 1% of patients with chronic myelocytic leukemia. Priapism has a relatively high complication rate, and management generally focuses on prompt treatment. Hematologic screening should be performed to rule out the possibility of these disorders that could underlie priapism.

Bone marrow aspiration and biopsy (BMAB) is a valuable diagnostic procedure commonly performed for evaluation of a wide spectrum of diseases including hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, and tumor treatment response such as chemotherapy and bone marrow transplantation, hematologic tumor staging, and suspected infection in patients with fever of unknown origin. This minimally invasive intervention offers excellent safety profile and a high diagnostic yield. Radiologists should be familiar with clinical implications of BMAB for patient care and be able to implement various technical armamentarium available to achieve a safe intervention while maximizing procedure yield. [ABSTRACT FROM AUTHOR]

Background: Various drugs, including ketamine and midazolam, are used for sedation in children. Objectives: This study aimed to evaluate the effectiveness of intravenous midazolam and ketamine combination in bone marrow aspiration and biopsy in children with cancer. Methods: This descriptive cross-sectional study was conducted on 100 children aged six months to 17 years candidates for bone marrow aspiration or biopsy. Sampling was easy, accessible, and sequential. Children were injected with 0.05 mg/kg midazolam and 1 mg/kg ketamine for sedation and analgesia. Then, sedation rate, restlessness, nausea, vomiting, laryngospasm, and decreased oxygen saturation were assessed. Data were analyzed using SPSS version 18 software. Results: The mean age of children was 6.8 ± 4.3 years. The mean degree of sedation based on the modified Ramsey score was 5.2 ± 0.74. Nausea and vomiting were observed in nine (9%) children. Six (6%) children had arterial saturation of less than 90%. Twelve (12%) children showed restlessness when waking up. There were no cases of laryngeal spasms. Conclusions: The present study showed that the intravenous midazolam and ketamine combination provides suitable sedation and analgesia to children, with low and negligible side effects. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis-related hemophagocytic lymphohistiocytosis (VL-HLH) is a secondary hemophagocytic syndrome, which can be life-threatening, caused by leishmania and transmitted by infected sandflies. Rapid and accurate identification of leishmania is crucial for clinical strategies. Case report: Here, we report an infantile infection in a non-epidemic area of China. The infant was a 9.5-month-old girl with fever, pancytopenia and hepatosplenomegaly, which meet the HLH-2004 standard, and the negative gene results exclude congenital HLH. However, chemotherapy is ineffective and is accompanied by severe infection. Fortunately, she is diagnosed with VL-HLH (visceral leishmaniasis-related hemophagocytic lymphohistiocytosis), as leishmania is detected by next-generation meta-genome sequencing (mNGS) and quickly relieved after treatment with libosomal amphotericin B (L-AMB). Conclusion: mNGS can detect leishmania in pediatric HLH, and should be performed as a new detection for VL-HLH, particularly for infants, who may not respond to HLH-2004 regimen.