Original Research

Indications and diagnostic value of bone marrow examination in HIV-positive individuals: A 3-year review at Tygerberg Hospital

Ibtisam Abdullah, Nadhiya Subramony, Ernest Musekwa, Erica-Mari Nell, Fatima Alzanad, Carissa Chetty, Ethan Gantana, Robert K. Lohlun, Wardah Cerfontein, Bridget Cochrane, Zivanai C. Chapanduka
Southern African Journal of Infectious Diseases | Vol 36, No 1 | a273 | DOI: https://doi.org/10.4102/sajid.v36i1.273 | © 2021 Ibtisam Abdullah, Nadhiya Subramony, Ernest Musekwa, Erica-Mari Nell, Fatima Alzanad, Carissa Chetty, Ethan Gantana, Robert K. Lohlun, Wardah Cerfontein, Bridget Cochrane, Zivanai C. Chapanduka | This work is licensed under CC Attribution 4.0
Submitted: 20 December 2020 | Published: 23 August 2021

About the author(s)

Ibtisam Abdullah, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Nadhiya Subramony, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Ernest Musekwa, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Erica-Mari Nell, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Fatima Alzanad, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Carissa Chetty, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Townn, South Africa
Ethan Gantana, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Robert K. Lohlun, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Wardah Cerfontein, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Bridget Cochrane, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa
Zivanai C. Chapanduka, Department of Haematological Pathology, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Cape Town, South Africa


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Abstract

Background: Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital.

Methods: A retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured.

Results: Altogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients’ median age was 43 years and the interquartile range was 27–60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia.

Conclusion: Bone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.


Keywords

bone marrow examination; investigation of cytopenia; indications; diagnostic yield; diagnostic utility; HIV; lymphoma; leukaemia

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