Bone Marrow Evaluation for New Onset Pancytopenia.
Elizabeth P Weinzierl, Daniel Arber. Stanford University School of Medicine, CA
Background: The new onset of pancytopenia often creates a diagnostic dilemma to the treating physician. In the absence of an obvious etiology, pancytopenia often leads to bone marrow aspiration and biopsy.
Design: To determine the distribution of bone marrow findings in such cases in a tertiary academic medical center, we evaluated 250 recent, subsequent bone marrow biopsies performed in the setting of new onset pancytopenia in patients without previously diagnosed hematologic disease.
Results: Of the 250 bone marrow studies, 193 (77%) were performed in adults, and 57 (23%) were performed in children 18 years and younger. In children, the most prevalent bone marrow finding was B-lymphoblastic leukemia (61% of pediatric cases), followed by nonspecific changes (17.5%) attributed clinically to a variety of factors including multifactorial, autoimmune, inflammatory, and infectious etiologies. The remainder of pediatric cases was essentially evenly distributed and included such diagnoses as aplastic anemia (5.3%), parvovirus infection (3.5%), acute myelogenous leukemia (AML) (3.5%), and a variety of rarer etiologies. In adults, the most common bone marrow findings were nonspecific changes (28.5% of adult cases) attributed clinically to a variety of etiologies including multifactorial, drug-induced, and infectious etiologies, as well as such entities as hypersplenism and systemic disease. Myelodysplastic syndrome was also a common diagnostic finding in adults (26.9%), the most common subtypes being RAEB-1, RAEB-2, and refractory cytopenia with multilineage dysplasia. Additionally, 21.2% of adult bone marrows demonstrated AML, the most common subtype being AML with myelodysplasia-related changes. Less common etiologies in adults included aplastic anemia (8.3%), myelofibrosis (3.1%), B-lymphoblastic leukemia (2.6%), various B-cell lymphomas (2.6%), plasma cell neoplasms (2.1%), hairy cell leukemia (1.6%), and metastatic carcinoma (1.0%).
Conclusions: In our series, new onset pancytopenia was most commonly associated with neoplasia, although the underlying neoplasm differed by age group. Although in the majority of cases a definitive diagnosis could be made based solely on bone marrow aspirate and biopsy interpretation, a significant fraction of cases in both children and adults demonstrated nonspecific marrow findings that required clinical follow-up for definitive diagnosis.
Monday, February 28, 2011 1:00 PM
Poster Session II # 163, Monday Afternoon