Evaluation Of Bone Marrow Smear And Biopsy Examinations In Diagnosis For Children With Hematologic Diseases

Objective:To study the diagnostic value of observation on both bone marrow smear and biopsy examination in diagnosis for children with hematologic diseases.Methods:1. A retrospective review of the medical records of 102 patients with hematologic diseases between February 2004 and August 2010.2. The data were analyzed with the single factorχ2 test.Results:1. In the 27 cases of myelodysplastic syndrome, there were 3 cases diagnosed by bone marrow smear while 24 cases by bone marrow biopsy. There was significantly difference between the two examinations. ALIP occurred in 21 cases of bone marrow biopsy, in which 3 cases died within 3 years after diagnosis. There was one case converting to leukemia from MDS associating with MF after 3 months. Abnormal proliferation of fibrous tissue could be found by bone marrow biopsy in children with MF while bone marrow smear could not.2. In the 32 cases of aplastic anemia, there were 23 cases diagnosed by bone marrow smear and 21 cases by bone marrow biopsy. There was no significant difference between the two examinations. In some hyperplastic AA or chronic AA, the bone marrow smear showed atypical dysplasia. Bone marrow biopsy prompted low proliferative MDS in one case of AA. 3. 54.5% of the 11 cases with ITP were chronic ITP. 54.5% of the 11 cases'blood were two-line or three-line decline. One of the bone marrow smear prompted AA probably. One of the bone marrow biopsy was suspected to be MDS.4. Four cases with hemophagocytic syndrome were inconsistent in bone marrow smear and biopsy. In bone marrow smear, there was one case prompted hemophagocytic syndrome and two cases were prompted MDS. In bone marrow biopsy, there was one case prompted hemophagocytic syndrome, one case prompted MDS, and one case prompted myeloid leukemia; Three cases of anemia were non-simple anemia associating with thrombocytopenia. Myelofibrosis occurred in bone marrow biopsy in one of the cases which diagnosed as hemolytic anemia.5. One case of Evan's syndrome prompted three-line decline in the peripheral blood. Bone marrow smear signified erythroid hyperplasia and thrombocytopenia. Bone marrow biopsy suggested no ALIP phenomenon.6. Two cases of acute myeloid leukemia were confirmed by bone marrow smear. The case of chronic myelogenous leukemia was confirmed by bone marrow biopsy while its bone marrow smear was normal.7. The course of the neutropenia was up to 9 months. In the bone marrow smear, the bone marrow proliferation was reduced and the erythroid was rare. The bone marrow biopsy showed poor proliferation of erythroid and granulocyte. There was no ALIP phenomenon.8. Three cases of bone marrow smear were found tumor metastases in 2 case of lymphoma and 2 case of neuroblastoma while bone marrow biopsy were all found metastases.9. In the 15 cases of unknown diagnosis,11 cases were related with MDS or AA. Seven patients were followed up in the 11 patients. In the seven follow-up patients, two were diagnosed as MDS and two were diagnosed as AA. Two were cured and one was diagnosed as acute leukemia.Conclusions :1. Bone marrow biopsy is more valuable than bone marrow smear in diagnosis of myelodysplastic syndrome. The onset of ALIP and MF usually signify poor prognosis.2. There is no significant difference between the diagnosis of AA by bone marrow biopsy and bone marrow smear. If the bone marrow smear prompted atypical AA( Proliferative AA or Chronic aplastic anemia),bone marrow biopsy should be performed in order to differentiate ITP and MDS(Hypoplastic MDS) avoiding misdiagnosis.3. In some atypical ITP or chronic ITP,if the treatment is ineffective ,bone marrow biopsy should be performed to rule out AA and MDS ,avoiding delays in treatment caused by misdiagnosis.4. The bone marrow smear and biopsy are complementary in diagnosis of hemophagocytic syndrome and non-simple anemia. If the bone marrow smear notes haemolytic anaemia, bone marrow biopsy should be performed to watch out for MF.5. Bone marrow biopsy should be taken to identify MDS in Evan's syndrome.6. Bone marrow smear and biopsy may complement each other. Chromosome examination should be taken while bone marrow smear and biopsy can't confirmed.7. If the treatment of neutropenia is poor, bone marrow smear and biopsy should be performed to except for other blood diseases.8. Bone marrow biopsy is more easy than bone marrow smear to observe metastasis of tumor and MF.9. The AA-MDS syndrome should be considered when bone marrow smear and biopsy can't confirmed MDS or AA. Doing the follow-up work would provide clinical data for understanding the development of diseases.