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. Bone marrow trephine biopsy was performed using Jamshidi needle from posterior superior iliac spine while aspiration was performed from same site using a spinal needle.

Results: A total of 111 bone marrow biopsy procedures were performed. The procedure was performed with ease in 68.4% of the cases by competent residents. In 27.9% cases procedure was performed with difficulty due to patient related causes which included immobility, displaying non-cooperation or irritability, or difficulty in the localization of the bone.  Maximum diagnosis ( 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%)in almost half of the cases. Concordance was present between the suspected diagnosis and the conclusive diagnosis made in the bone marrow biopsy report. Bone marrow was found to be normal in 13.5% (n=15) patients. 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: 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