Clinico-hematological portrait of bone marrow infections: Unusual visitors unveiled

Abstract

Background: Bone marrow examination is a crucial diagnostic tool for both hematological and non-hematological
disorders, ranging from benign to malignant ones. It is a relatively simple and easy procedure for evaluating pyrexia of
unknown origin, as it often leads to an etiological diagnosis. The study aims to evaluate the clinico-hematological profile
in various infections infiltrating bone marrow and study the spectrum of morphologic alterations in bone marrow
aspirate in various infections.
Methodology: This retrospective observational study was conducted at a tertiary care center in Bihar, India, over a 4.5
year period (June 2019–December 2023). All patients referred to the haematology section for bone marrow aspiration
and/or biopsy based on strong clinical and morphological suspicion of infection were included. Cases with inadequate
marrow samples or lacking corroborative infection evidence were excluded.
Results: The study included a total of 52casesdemonstratingthe presence of bone marrow infections. Out of 52 cases,
bone marrow aspirations were done in all cases, whereas bone marrow biopsy was done in 23(44.2%) cases only. There
were 39 (75%) cases of adults and 13 (25%) of children; and the mean age of presentation was 35.3 years (range, 1-72
years).
On clinical examination, anemia was the most common symptom (82.6%), followed by splenomegaly (78.8%). On bone
marrow examination, an increase in plasma cells was the most striking finding, accounting for 67.3% (n=35), followed
by erythroid hyperplasia and an increased number of macrophages showing features of hemophagocytosis in 50% and
32.6% of cases, respectively. A total of 41 cases showed the presence of Leishmania Donovani (LD) bodies.
Granulomas were seen in 09 cases (17.3%), out of which 05(9.6%) cases showed AFB positivity.
Conclusion: Bone marrow examination plays a pivotal role in diagnosing various infectious diseases, particularly in
patients presenting with pyrexia of unknown origin, cytopenias, or unexplained hematological abnormalities.
Morphological analysis, along with specialized staining techniques, allows the identification of a broad spectrum of
infectious agents, spanning from parasites and bacteria to fungi.