Effectiveness of Bone Marrow Biopsy for the Diagnosis of Pyrexia of Unknown Cause

Keywords: Pyrexia of Unknown Origin, Bone Marrow Biopsy, Bone Marrow Aspirate.

Abstract

Background: Diagnosis of fever of unidentified cause remains challenging despite the availability of modern diagnostic techniques. Pyrexia of Unknown Origin (PUO) may result from various etiologies, among which infectious diseases are largely responsible. Many diagnostic approaches are currently applied. A detailed history with a complete general physical examination followed by baseline investigations with other specific tests like imaging, microbiological tests, and biopsies is employed to diagnose PUO. This study was designed for the evaluation and effectiveness of bone marrow biopsy in the identification of PUO and highlighted the existing spectrum of diseases involved in PUO.

Methodology: This Cross-sectional study was conducted at Dow University of Health Sciences, Karachi from 2015 to 2018 evaluated the records of patients who had bone marrow aspiration and biopsy Patients included in this study had a history of fever due to an Unfamiliar cause and met the Peters Dorf and Beeson criteria for PUO, i.e. fever for more than 3 weeks before diagnosis. Informed consent was taken from all patients.

Results:  We analyzed the medical histories of 67 patients (48 males and 19 females) who were recommended bone marrow biopsy and aspiration for the assessment of PUO. The mean age was 38 years. The most common clinical symptoms found in patients of PUO were fever, hepato-splenomegaly followed by abdominal pain and weight loss. Anemia was the most common hematological parameter found in this study. The most frequent diagnosis in biopsies of PUO patients was Non-Hodgkins Lymphoma in about 25% of patients.

Conclusion: Certain laboratory and clinical parameters can detect major hematological diseases like malignancies when bone marrow biopsy is used for the workup of pyrexia of unknown origin. Bone marrow biopsy should be regarded as a constitutive part of the workup and diagnosis of pyrexia of unknown origin in conjunction with clinical findings.

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References

1. Ben-Baruch S, Canaani J, Braunstein R, Perry C, Ben-Ezra J, Polliack A, Naparstek E, Herishanu Y. Predictive parameters for a diagnostic bone marrow biopsy specimen in the work-up of fever of unknown origin. InMayo Clinic Proceedings 2012 Feb 1 (Vol. 87, No. 2, pp. 136-142). Elsevier.
2. Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine. 1961;40:1-30.
3. Durack DT. Street A.C. Fever of unknown origin--reexamined and redefined. Curr Clinical Topics Infec Dis. 1991;11:35-51.
4. Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Internal Med. 2003;253(3):263-275.
5. Bharucha T, Cockbain B, Brown M. Pyrexia of unknown origin in clinical practice. Bri J Hospital Med. 2016;77(10):579-583.
1. Ben-Baruch S, Canaani J, Braunstein R, Perry C, Ben-Ezra J, Polliack A, Naparstek E, Herishanu Y. Predictive parameters for a diagnostic bone marrow biopsy specimen in the work-up of fever of unknown origin. InMayo Clinic Proceedings 2012 Feb 1 (Vol. 87, No. 2, pp. 136-142). Elsevier.
2. Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine. 1961;40:1-30.
3. Durack DT. Street A.C. Fever of unknown origin--reexamined and redefined. Curr Clinical Topics Infec Dis. 1991;11:35-51.
4. Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Internal Med. 2003;253(3):263-275.
5. Bharucha T, Cockbain B, Brown M. Pyrexia of unknown origin in clinical practice. Bri J Hospital Med. 2016;77(10):579-583.
Published
2021-03-01
How to Cite
Sajjad, M., Kouser, S., arshad, fatima, Fatima, A., Tauheed, M., Minhas, S., Mehmood, M., Qadir, H., & Mansoori, H. (2021). Effectiveness of Bone Marrow Biopsy for the Diagnosis of Pyrexia of Unknown Cause. International Journal of Endorsing Health Science Research (IJEHSR), 9(1), 48-54. https://doi.org/10.29052/IJEHSR.v9.i1.2021.48-54