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Published on: November 10, 2023
[Usefulness of bone marrow microscopic examination in HIV-infected patients with pancytopenia]
Héctor Manuel Madrigal-jiménez1, Gabriela Hernández-Rivera
1Departamento de Hematología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México, DF México.
Introduction:
The role of bone marrow examination in the diagnosis of prolongedfever in HIV infected patients, has been well established, but the importance of the morphological and etiological analysis, obtained in patients with coexisting pancytopenia, has not been adequately described.
Materials And Methods:
In a prospective study, we recruited 31 HIV-infected patients with coexisting pancytopenia, with or withoutfever. Bone marrow examination was performed in all cases. Other studies were done to confirm diagnosis.
Results:
Parvovirus infection was observed in 5 patients, Histoplasma capsulatum in 4, Mycobacterium tuberculosis in 2, Mycobacterium avium complex in 3, HIV in 3, Salmonella typhi in 2, pneumonia and an unknown agent in 2 and intestinal infection and an unknown agent in 2. Only one patient was included in the following diagnostic etiologies: cytomegalovirus, trimethoprim sulfamethoxazole, Hodgkin's disease, hypersplenism, acinetobacter, appendicitis with an unknown agent, E. coli, and hemophagocytic syndrome. We obtained a probable diagnosis in 12 out of 31 patients (38.7), using bone marrow examination.
Conclusion:
In this subgroup of patients, the microscopic analysis of bone marrow is an important clinical approach that can lead to an early diagnosis of patients with and without fever.
Insights
Bone marrow examination is crucial for diagnosing prolonged fever in HIV patients with pancytopenia. Microscopic analysis aids early etiological diagnosis, even without fever, improving patient outcomes.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Context:
- Prolonged fever in Human Immunodeficiency Virus (HIV)-infected patients often requires thorough investigation.
- Pancytopenia, a common complication in HIV, necessitates understanding underlying causes.
- The diagnostic utility of bone marrow examination in this specific patient group remains underexplored.
Purpose:
- To evaluate the role of bone marrow examination in diagnosing the causes of prolonged fever in HIV-infected patients presenting with pancytopenia.
- To determine the etiological spectrum and diagnostic yield of bone marrow analysis in this cohort.
Summary:
- A prospective study involved 31 HIV-infected patients with pancytopenia, with or without fever.
- Bone marrow examination was performed, revealing various infections (Parvovirus, Histoplasma, Mycobacterium, Salmonella Typhi) and other conditions.
- A probable diagnosis was achieved in 38.7% of patients through bone marrow examination.
Impact:
- Bone marrow examination provides critical morphological and etiological insights in HIV patients with pancytopenia.
- This diagnostic approach facilitates early identification of infections and other underlying conditions.
- Microscopic analysis of bone marrow is a valuable tool for timely diagnosis in febrile and afebrile HIV-positive individuals.
