Division of Haematological Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS), Tygerberg Hospital, South Africa.
Int J Lab Hematol. 2023 Aug;45(4):553-561. doi: 10.1111/ijlh.14079. Epub 2023 May 2.
Bone marrow examination (BME) is a reliable and effective tool in the diagnosis of many haematological and non-haematological diseases and may be used to investigate unexplained cytopenia in human immunodeficiency virus (HIV) infected patients. The objective of this study was to determine the diagnoses made, diagnostic yield and unique diagnostic yield of BMEs performed to investigate cytopenias in HIV infected patients.
A retrospective cross-sectional descriptive study was performed involving all BMEs performed on HIV-infected adult patients with the main indication of unexplained cytopenia over a period of 5 years and 4 months. Data was extracted from the National Health Laboratory Service's laboratory information system and clinicians' BME request forms.
The study included 128 BMEs, performed on 124 patients. The diagnostic yield was 32% and the unique diagnostic yield was 30.5%. The most common diagnosis was pure red cell aplasia (10.9%), followed by immune thrombocytopenic purpura (ITP) (7%), iron deficiency anaemia (6.3%), malignancy (4.7%) and disseminated infection (3.9%).
BME is a useful investigation for unexplained cytopenia in HIV-infected patients. Less invasive investigations to exclude haematinic deficiencies, haemolysis and sepsis are recommended on an individualised basis prior to BME. In HIV-infected patients with therapy refractory ITP or ITP with atypical clinicopathological findings, BME is strongly recommended. As Mycobacterial and other infections are common in this group of patients, staining and culture of specimens are advised if BME is undertaken.
骨髓检查（BME）是诊断许多血液学和非血液学疾病的可靠且有效的工具，可用于研究人类免疫缺陷病毒（HIV）感染患者的不明原因血细胞减少症。本研究的目的是确定进行 BME 以调查 HIV 感染患者血细胞减少症的诊断、诊断率和独特诊断率。
回顾性横断面描述性研究，涉及在 5 年零 4 个月的时间内，对因不明原因血细胞减少而接受主要指示为 BME 的所有 HIV 感染成年患者进行的所有 BME。数据从国家卫生实验室服务的实验室信息系统和临床医生的 BME 请求表中提取。
该研究共纳入 128 例 BME，对 124 例患者进行了检查。诊断率为 32%，独特诊断率为 30.5%。最常见的诊断是纯红细胞再生障碍（10.9%），其次是免疫性血小板减少性紫癜（ITP）（7%）、缺铁性贫血（6.3%）、恶性肿瘤（4.7%）和播散性感染（3.9%）。
BME 是 HIV 感染患者不明原因血细胞减少症的有用检查方法。建议根据个体情况，在进行 BME 之前，进行不太侵入性的检查以排除血液缺乏、溶血和败血症。对于治疗耐药性 ITP 或具有非典型临床病理表现的 ITP 的 HIV 感染患者，强烈建议进行 BME。由于该组患者中常见分枝杆菌和其他感染，建议在进行 BME 时对标本进行染色和培养。
