Clinical audit of bone marrow examination - suggesting the impact of procedural checklist to improve its quality

Abstract

Objective: The purpose of bone marrow biopsy includes diagnosis, staging, prognosis, and treatment response for various hematological and non-hematological disorders. The present study aimed to observe the frequent indications for the performance of bone marrow biopsy and the frequencies of various disorders diagnosed using the procedure.

Methodology: This descriptive retrospective audit was conducted in the Hematology section at Indus Hospital and Health Network and included bone marrow biopsies performed from January 2021 to October 2022 with patients >16 years and belonging to either gender.

Results: A total of 111 bone marrow biopsy procedures were performed. The median age of the study participants was 45 years with slight male preponderance. The most frequent indication for the procedure was visceromegaly. Maximum diagnosis (n=70; 63.1%) was made when the core depth was >1.0 cm. Hematological diseases were the most common diagnosis (69.4%); of which the majority were malignant (70.1%). Chronic myeloid leukemia (n=17; 22.1%) and aplastic anemia (n=9; 11.7%) were the most frequent malignant and benign disorders respectively. The overall diagnostic yield for the present study was 82.9% while based on indication, visceromegaly produced a yield of 87.1%.

Conclusion: Bone marrow examination can be considered an important diagnostic tool for various hematological disorders. Splenomegaly was observed to be the most common indication for procedure referrals in our center. Core size of >1.0 cm was found to have the highest diagnostic utility. Chronic Myeloid Leukemia and aplastic anemia were the most frequent hematological diagnoses in the present study. Visceromegaly had the highest diagnostic yield.