Quantitative analysis of bone marrow in pancytopenic dogs

The pancytopenia can be associated with intra and extra medullary disorders. When the etiology is not obvious, the examination of bone marrow is necessary. The study aims to report and discuss quantitative amendments in bone marrow and their causes in dogs with pancytopenia. Bone marrow aspirate was obtained from 65 dogs with pancytopenia over a period of 13 consecutive months for preparation of smears stained by Giemsa and observed in light microscopy. Five hundred cells differential count was held; and assessed myeloid:erythroid ratio, cellularity, megakaryocytes and direct parasitological examination. The data were evaluated by the Chi-square statistical test. Blood tests of 3120 canines with several clinical changes were analyzed to identify pancytopenia, which accounted for 167 (5.4%) dogs. Interpretation of quantitative characteristics was carried out from the bone marrow smear in 65 pancytopenic dogs and the etiology was established in 40 (61.5%) of these, which included infection by E. canis and L. chagasi, idiopathic aplastic anemia, chronic renal failure and co-infections. In 17 (26.2%) animals were not observed medullary changes. The most bone marrow change was observed myeloid and erythroid hypoplasia in 17 (26.2%) dogs, followed by myeloid and erythroid hyperplasia (24.6%). The myelogram association to the blood cell count allowed the identification of medullary findings and its participation on the occurrence of pancytopenia cases. The number of cases resulting from infectious diseases was 38 (58.5%) in canine assessed: significant number due to its endemic characteristic of the study region.

Correlation Between Peripheral Blood Counts and Day 14 Bone Marrow Biopsy in Acute Myeloid Leukemia during Induction Chemotherapy

Background Current NCCN guideline recommends that a bone marrow sample be performed 7-10 days (day 14 bone marrow) after completion of induction therapy in newly diagnosed acute myeloid leukemia (AML). However, the value of day 14 bone marrow has been questioned due to the invasive nature of the procedure and lack of specificity pertaining to complete remission in cases of borderline blasts count and cellularity. We examined peripheral blood count and bone marrow from day 0 to day 14, to see if a reduction of peripheral blood correlated and predicted the day 14 bone marrow morphologic changes and complete remission (mCR). Methods We did 10 years retrospective review between year 2004 and 2013 at the Henry Ford Hospital, on patients who had newly diagnosed AML and day 14 bone marrow biopsy. The majority of patients underwent "7+3" or a "7+3"-like regimen for induction chemotherapy. Firstly, we evaluated the relationship of change of peripheral blood count from day 0 to day 14 with blast percentage and cellularity of bone marrow. Spearman correlations coefficients were computed for each pair of characteristics. Peripheral blood count includes neutrophil (ANC), monocyte, white blood cells (WBC), blast, hemoglobin and platelet. Secondly, we investigated the possible correlation of mCR to peripheral blood and bone marrow changes, using binary univariate logistic regression. mCR as defined by blast percentage <5, absolute neutrophil (ANC) >1000/mm3, platelets>100,000/mm3. Thirdly, we explored differences in peripheral blood counts on day 14 among three bone marrow groups, those with blast percentage <5, 5-20, >20. Results A total of 200 patients were reviewed and 56 patients met the inclusion criteria. Decrease of ANC/WBC correlated with decrease of bone marrow blast/cellularity from day 0 to day 14 (ANC: Blast P ≤ 0.05; ANC: cellularity P ≤ 0.05; WBC: blast P ≤ 0.001, WBC: cellularity P ≤ 0.01). In other words, a larger reduction in ANC/WBC correlated with larger reduction in both blast and cellularity in bone marrow. However, this correlation with bone marrow change was not found in peripheral blast, monocyte, hemoglobin and platelet. We also found that with increasing age, there was less reduction from day 0 to day 14 in bone marrow blast and cellularity. Bone marrow blast and cellularity on day 14 is strongly associated with mCR (P<0.01), the reduction of blast (43.7 +/- 22.86, Odds ratio 1.03 (1.01, 1.06), P=0.012) and cellularity (66.21 +/- 29.98, Odds ratio 1.03 (1.01, 1.05), P=0.003) from day 0 to 14 is also predictive for mCR. Interestingly, there is a trending effect that the reduction of ANC from day 0 to 14 may predict mCR, but it is not statistically significant (Odds ratio 1.22 (1.02, 1.66), P=0.097). The reduction of WBC is not associated with mCR. Furthermore, peripheral blood counts on day 14 are similar among 3 bone marrow groups, those of blast percentage <5, 5-20, and >20% on day 14. Conclusion ANC/WBC decrease from day 0 to day 14 correlated with the decrease in bone marrow blast count and cellularity, and can be used as a predictor for bone marrow change on day 14, but the level of day 14 peripheral blood findings are similar among 3 bone marrow groups (blast percentage <5, 5-20, and >20% on day 14), so it could not be used to predict the level of bone marrow change. Our data confirmed that the significant decrease of bone marrow blast percentage and cellularity from day 0 to 14 predicts mCR. Decrease of ANC from day 0 to 14 may also predict mCR although it is not statistically significant. A larger sample size can be studied in the future to further explore the possibility of using peripheral blood to predict bone marrow changes and mCR. Summary Our data demonstrates a significant reduction of ANC on day 14 after induction therapy in newly diagnosed AML, which correlates with a decrease in bone marrow cellularity and blast percentage. However, a statistically significant association with blast percentage pertaining to mCR was not obtained. In conclusion, while the current findings do not justify replacement of day 14 bone marrow for predicting mCR, further large scale studies are indicated. Disclosures No relevant conflicts of interest to declare.

Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging

Background/Aim. Bone bruise is a common finding in acutely injured knee examined by magnetic resonance (MR). The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament (ACL) and menisci. Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage. MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques. Methods. A representative review of 120 MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma. All MR examinations were performed by using a 0.3T MR unit. Results. Posttraumatic bone bruise was seen in 39 (32.5%) patients out of 120. Three patients had fracture of the cortex, so-called ?occult? fracture (not seen on plain radiography). We analyzed only bone bruises without these fractures of the cortex. Bone bruise was associated with the lesion of ACL in 27 (69%) patients. In 28 (72%) patients bone bruise was in combination with the lesion of menisci. Only two patients with bone bruise had neither ACL nor menisci lesions. There were 78 patients without bone bruise but 33 (43%) of them had lesions of ACL and 49 (63%) had lesions of menisci. Conclusion. Bone bruise is best seen in STIR (Short TI Inversion Recovery) images and is very often found in acute knee trauma. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen. The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

The paediatric wrist revisited: redefining MR findings in healthy children

ObjectivesDuring a multicentre study on juvenile idiopathic arthritis, wide variations were observed in bone shape, signal intensity and volume of joint fluid as shown by MRI which in part appeared to be unrelated to disease activity. A study was undertaken to examine these features in a cohort of healthy children.Methods88 children of mean age 9.8 years (range 5–15) underwent MRI imaging (T1-weighted Spin Echo and Spectral Selection Attenuated Inversion Recovery (SPAIR)) of the left wrist. The number of bony depressions, distribution and amount of joint fluid and the presence of bone marrow changes were assessed.ResultsBony depressions were present in all children, increasing with age from a mean of 4.0 in children aged 4–6 years to 9.2 in those aged 12–15 years (p<0.001)). 45 of 84 children (53.6%) had a high signal on SPAIR with a corresponding low signal on T1 in at least one bone. No associations were seen between bone marrow change (present or not) and sex (p=0.827) or sports club membership (p=0.616). All children had visible joint fluid in at least one of the joints assessed. No associations were seen between the presence of joint fluid and age group, except for the radius/scaphoid and capitate-scaphoid joints and a recess lateral to the hamate.ConclusionsIt is important to be aware of the high prevalence of bony depressions, signal changes suggestive of bone marrow oedema and the volume of joint fluid seen in normal children. Such findings must be interpreted with care in children with suspected disease such as juvenile arthritis.