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Background
The purpose of the work was to assess the contribution to diagnosis and/or treatment (CDT) of bone marrow aspiration (BMA) in the critically ill patient.
Methods
The retrospective study included 193 patients. On the basis of BMA findings, contribution to diagnosis was defined by one of four previously unestablished diagnoses (maturation...
Contexts in source publication
Context 1
... had a CDT in 40 patients (20.7%). It contributed to diagnosis in 37 patients and to treatment in 14 (Table 2). In the 10 patients with maturation arrest of granulocyte precursors, exposure to potentially hematotoxic agents within the preceding 7 days was identified in all cases, but corresponded to an immunosuppressive treatment in only one case (Additional file 5). ...
Context 2
... the 14 patients with a BMA contributing to treat- ment, BMA findings resulted in initiation of treatment in 8, discontinuation in 3, and a DFLST in the other 3, established on the basis of the reported diagnosis (acute myeloid leukemia) against a background of worsening critical state (Table 2). No post-BMA complications were observed. ...
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Methods:
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Citations
... BMB is useful in the investigation of PUO as it leads to an etiological diagnosis in most cases [4]. BMA leads to a specific diagnosis, guides specific treatment, prevents potentially ineffective or harmful treatment, and provides important prognostic information [5]. BMB is a rapid test for clinical decision making in suspected cases of mycobacterial infection or hematological malignant diseases [2]. ...
Introduction: Bone marrow examination (BME) is a useful tool in the diagnosis of haematological and non-haematological diseases. It plays an important role in early diagnosis of the underlying cause of pyrexia of unknown origin (PUO) and can influence the management of patients. Bone marrow aspiration (BMA) plays a very important role in establishing a definitive diagnosis in cases of PUO. The aim of this study was to review the indications and usefulness of bone marrow aspirates sent for microbiological evaluation as a diagnostic tool with histopathological correlation. Methodology: A prospective study was conducted from 1 January 2017 to 30 September 2019 in the Department of Microbiology and Pathology on the bone marrow aspirates of patients of all groups. Results: A total of 148 bone marrow aspirates were included. The cases were categorized as classical PUO (n = 81/148, 54.7%), nosocomial PUO (n = 4 /148, 2.7%), neutropenic PUO (n = 18/148, 12.1%), and immunocompromised PUO (n = 45/148, 30.4%), among which were systemic lupus erythematosus cases n = 8/45 (22.2%), human immunodeficiency virus positive cases n = 10/45 (17.7%), and renal transplant cases n = 27/45 (60%). A total of 28 BMAs were positive for microorganisms, out of which bacterial pathogens were n = 12 (42.8%), mycobacterial n = 12, 42.8%, fungal (n = 3, 10.7 %), and viruses (n = 1, 3.5%). Conclusions: This study helped in highlighting the role of bone marrow examination as an important diagnostic method in the diagnosis of infectious diseases.
... As a result, the authors concluded that BMA could significantly contribute to diagnosis and treatment in patients with or without any hematological malignancy during admission to the intensive care unit. 7 In our study, the BMA evaluation directly contributed to the diagnosis and treatment of 200 (40%) patients, including 186 (37.2%) with malignant hematological diseases and 14 (2.8%) with benign hematological diseases. In a study by Gilotara et al. in 100 cases, when the results of BMA and BMB assessment were compared, there was a 72.4% agreement. ...
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.
... Persistent fever that is refractory to antibiotics, pancytopenia, major hyperferritinemia, or unexplained liver enzyme elevation should lead practitioners to screen patients for HLH (35)(36)(37). Although variable and non-specific, bonemarrow hemophagocytosis is still a hallmark HLH criterion (38)(39)(40) and was associated with a higher ICU mortality rate in our study. Among biological factors, non-regenerative profound anemia and hypofibrinogenemia have been reported to be independent predictors of a poor outcome (31)(32)(33)41). ...
Background: Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult HLH in the ICU (ICU-HLH). We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population.
Methods: This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (≥ 4/8) and/or had an HScore ≥ 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH.
Results: Two hundred and sixty patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% ( n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02).
Conclusions: In this large retrospective cohort study of critically ill patients, ICU-HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology or specific treatment. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.
... [1,4,[9][10][11][12] [4,13] The diagnosis of HLH forms a challenge since many of its symptoms are nonspecific. [14,15] HLH is currently diagnosed according to the presence of at least 5/8 of the HLH-2004 criteria: fever, splenomegaly, increased ferritin, high soluble cluster of differentiation 25 (sCD25), cytopenia in at least two cell lineages, tissue phagocytosis, low NK lymphocyte-mediated lysis of target cells, and either high triglycerides or low fibrinogen. [16] Since the triggers for HLH vary, it is assumed to be a heterogeneous disease and there is debate whether this heterogeneity has implications for the diagnostic process. ...
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immune dysregulation syndrome characterized by uncontrolled immune cell activation. Timely diagnosis is important, since early treatment can improve survival rates. However, completing all assessments needed to reach ≥5 positive criteria out of the 8 HLH-2004 criteria can be time consuming and may delay timely initiation of treatment. Hence, we applied a data-driven approach to identify a minimal parameter set for early decision-making towards the initiation of HLH-specific treatment. We retrospectively evaluated 165 patients from five Dutch tertiary hospitals with suspected HLH. Sixteen pHLH (median age 0.5 years) and 70 sHLH patients (median age 8.7 years) were identified using the HLH-2004 criteria. Clustering analysis and multi-receiver operator characteristics were used to identify parameters distinctive of HLH. The presence of either increased ferritin, cytopenia in ≥2 lineages, or splenomegaly distinguished HLH from non-HLH cases with a negative predictive value of 100%. A minimal parameter set consisting of 2 major criteria (phagocytosis and splenomegaly) and 3 minor criteria (cytopenia, increased ferritin, and increased triglycerides/low fibrinogen) predicted HLH with 95% (88–99) sensitivity and 94% (86–98) specificity. This finding was replicated in an independent retrospective validation cohort of 109 US patients ( n = 109). By dividing a subset of the HLH-2004 criteria into major and minor criteria, this strategy uses the evaluation of less than 5 criteria to quickly identify patients with HLH. When confirmed in a prospective setting, this approach could be of value for timely diagnosis and treatment of HLH.
... Persistent fever that is refractory to antibiotics, pancytopenia, major hyperferritinemia, or unexplained chemical hepatitis should lead practitioners to screen patients for HLH [31][32][33]. Although variable and non-speci c, bone-marrow hemophagocytosis is still a hallmark HLH criterion [34][35][36] and was associated with a higher ICU mortality rate in our study. Among biological factors, non regenerative profound anemia and hypo brinogenemia have been reported to be independent predictors of a poor outcome [27][28][29]37]. ...
Background
Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult-acquired HLH in the ICU. We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population,
Methods
This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (> 4/8) and/or had an HScore > 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH.
Results
260 patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02).
Conclusions
In this large retrospective cohort study of critically ill patients, ICU-acquired HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.
... There are several methods used to understand the underlying cause of thrombocytopenia. Given that, bone marrow aspiration (BMA (is an invasive procedure for examining the condition of megakaryopoiesis and thrombopoiesis, other alternative modalities have been suggested namely the Glycocalicn-index (GCI) [290]. GCI can be effective in determining the main cause of thrombocytopenia. ...
Primary immunodeficiency (PID) or Inborn errors of immunity (IEI) refers to a heterogeneous group of disorders characterized by immune system impairment. Although patients with IEI manifest highly variable symptoms, the most common clinical manifestations are recurrent infections, autoimmunity and malignancies. Some patients present hematological abnormality including thrombocytopenia due to different pathogenic mechanisms. This review focuses on primary and secondary thrombocytopenia as a complication, which can occur in IEI. Based on the International Union of Immunological Societies phenotypic classification for IEI, the several innate and adaptive immunodeficiency disorders can lead to thrombocytopenia. This review, for the first time, describes manifestation, mechanism and therapeutic modalities for thrombocytopenia in different classes of IEI.
Background
Ferritin is an established biomarker in the diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH), which is diagnosed by the HLH‐2004 criteria. Among these criteria, detection of hemophagocytosis through invasive procedures may delay early life saving treatment. Our aim was to investigate the value of hemophagocytosis in diagnosing HLH in critically ill patients.
Methods
In this secondary analysis of a retrospective observational study, we included all patients aged ≥18 years and admitted to any adult ICU at Charité—Universitätsmedizin Berlin between January 2006 and August 2018, who had hyperferritinemia (≥500 μg/L) and underwent bone marrow biopsy during their ICU course.
Results
Two hundred fifty‐two patients were included, of whom 31 (12.3%) showed hemophagocytosis. In multivariable logistic regression analysis, maximum ferritin was independently associated with hemophagocytosis. By removing hemophagocytosis from HLH‐2004 criteria and HScore, prediction accuracy for HLH diagnosis was only marginally decreased compared to the original scores.
Conclusions
Our results strengthen the diagnostic value of ferritin and underline the importance of considering HLH diagnosis in patients with high ferritin but only four fulfilled HLH‐2004 criteria, when hemophagocytosis was not assessed or not detectable. Proof of hemophagocytosis is not required for a reliable HLH diagnosis.
Introduction: Bone marrow aspiration is a safe, simple and minimally invasive procedure used for evaluation of hematological disorder. It is useful when diagnosis from the first line investigations are inconclusive. Objectives: To compare the clinical findings and bone marrow aspiration cytology findings Methodology: This is a prospective hospital based cross sectional study carried out in Birat Medical College. Simple random consecutive sampling was done in patients that underwent bone marrow aspiration from December15th 2021 to June 14th 2022. Dry tap, patient under treatment and inadequate material were excluded from the study. After informed consent, BMA was done from the right or left posterior superior iliac crest using local anesthesia. Smeared slides were stained by Wright stain and was examined by two pathologists. Special stain was not done. Ethical clearance was taken from Institutional Review Committee (IRC). Data collected was then tabulated by using Microsoft Excel sheet and SPSS Results: A total of 106 patients were included in this study with majority aged > 45 years (50.9%). The commonest indications for bone marrow aspiration was anemia under evaluation (35.9%) followed by pancytopenia under evaluation (22%). The most common diagnosis identified by bone marrow aspiration was mixed nutritional deficiency anemia (21.7%).In patients evaluated for pancytopenia six were diagnosed with hematological malignancy. Conclusion: Nutritional deficiency anemia, commonly indicated for bone marrow aspiration, was the most common cause diagnosed by bone marrow aspiration. Bone marrow aspiration is important to arrive at diagnosis especially in patients with anemia and pancytopenia.
Bone marrow biopsy and aspiration (BMBx) are common diagnostic procedures used for the diagnosis and monitoring of multiple conditions including hematologic malignancies, non-hematologic malignancies, infection, and metabolic processes. While these procedures can be done on the inpatient floor or in clinic, imaging guidance has been utilized to improve patient safety. This article will review the patient work-up and considerations, as well as technique for performing both computer tomography (CT) and fluoroscopic guided bone marrow biopsies.
Objectives:
Hemophagocytic lymphohistiocytosis is a cytokine release syndrome caused by uncontrolled immune activation resulting in multiple organ failure and death. In this systematic review, we aimed to analyze triggers, various treatment modalities, and mortality in critically ill adult hemophagocytic lymphohistiocytosis patients.
Data sources:
MEDLINE database (PubMed) at October 20, 2019.
Study selection:
Studies and case series of patients greater than or equal to 18 years old, of whom at least one had to be diagnosed with hemophagocytic lymphohistiocytosis and admitted to an ICU.
Data extraction:
Source data of studies and case series were summarized and analyzed on an individual basis. Multivariable logistic regression analysis was performed adjusting for age, sex, and trigger groups. Each single treatment agent was entered as a dichotomous variable to determine treatments associated with survival, regardless if given alone or in combination.
Data synthesis:
In total, 661 patients from 65 studies and case series were included. Overall mortality was 57.8%. Infections were the most frequent trigger (49.9%), followed by malignancies (28.0%), autoimmune diseases (12.1%), unknown triggers (9.4%), and drugs (0.6%). Treatment with IV immunoglobulins was associated with improved survival (odds ratio, 0.548; 95% CI, 0.337-0.891; p = 0.015), while treatment with cyclosporine was associated with increased risk of death (odds ratio, 7.571; 95% CI, 3.702-15.483; p < 0.001). Considering different trigger groups separately, same results occurred only for infection-triggered hemophagocytic lymphohistiocytosis. No information was available on disease severity and other confounding factors.
Conclusions:
Mortality of hemophagocytic lymphohistiocytosis in the ICU is high. Most common triggers were infections. Results of survival analyses may be biased by treatment indication and disease severity. Future studies prospectively investigating treatment tailored to critically ill hemophagocytic lymphohistiocytosis patients are highly warranted.
