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Yield of bone marrow examination in diagnosing the source of fever of unknown origin

Arnaud Hot1, Isabelle Jaisson, Charlotte Girard

  • 1Service de Médecine Interne, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon CEDEX 03, France. arnaud.hot@wanadoo.fr.

Archives of Internal Medicine
|November 26, 2009
PubMed
Abstract

Insights

Bone marrow biopsy aids in diagnosing prolonged fevers of unknown origin (FUO) in immunocompetent patients. Low platelet counts and anemia are indicators of its diagnostic value.

Area of Science:

  • Hematology
  • Internal Medicine
  • Diagnostic Pathology

Background:

  • Fever of unknown origin (FUO) presents significant diagnostic challenges, often requiring invasive procedures for etiological determination.
  • Tissue biopsy, specifically bone marrow biopsy (BMB), plays a critical role in the diagnostic workup of persistent febrile illnesses.

Purpose of the Study:

  • To evaluate the diagnostic yield and clinical utility of bone marrow biopsy in a cohort of non-immunocompromised patients with fever of unknown origin.

Main Methods:

  • A retrospective analysis of 130 consecutive non-immunocompromised patients with FUO who underwent bone marrow biopsy between 1995 and 2005.
  • Histological examination of bone marrow samples and correlation with clinical data.

Main Results:

  • Bone marrow biopsy yielded a specific diagnosis in 31 cases (23.7% diagnostic yield).
  • Hematological malignancies (lymphoma, leukemia, myeloma) were the most common findings (25 cases), followed by infections and systemic mastocytosis.
  • Thrombocytopenia (OR 4.9) and anemia (OR 3.24) were significant predictors of BMB's diagnostic usefulness.

Conclusions:

  • Bone marrow biopsy is a valuable diagnostic tool for immunocompetent patients with prolonged fever.
  • The presence of thrombocytopenia and anemia may indicate a higher likelihood of obtaining a diagnosis via bone marrow biopsy.

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