Indications and diagnostic utility of bone marrow examination in different bone marrow disorders in Iran

The shortage of published literature regarding the indications for bone marrow examination and the prevalence of hematologic disorders in the Middle East, especially Iran, prompted us to review 1154 bone marrow specimens sent to the Pathology Department of Rasoul Akram Hospital in Tehran from January 2002 to December 2006. We aimed to determine the diagnostic utility of the bone marrow examination for different bone marrow disorders by determining the clinical suspicion and indications for bone marrow examination for each patient and comparing these findings with the final pathologic diagnoses. The patients comprised 657 males and 497 females, with ages ranging from 1 to 95 years. The most frequent indication was pancytopenia, followed by suspicion of multiple myeloma, lymphoma, and follow-up of leukemia. After exclusion of 110 unsatisfactory and 416 normocellular specimens, the total number of bone marrow disorders was 628 (170 of reactive bone marrow and 458 of nonreactive marrow). Acute leukemia and plasma cell dyscrasia were the 2 most common new diagnoses among nonreactive marrows. In conclusion, bone marrow examination had the highest diagnostic yield with respect to suspicion of leukemia (54%), multiple myeloma (30.3%), myeloproliferative disorders (25%), and lymphoma (16.2%), and it was the least helpful in suspected cases of storage disorders (0%) and infection (2.2%).