Patterns of Bone Marrow Confirmed Malignant and Non-Malignant Hematological Disorders in Patients with Abnormal Hematological Parameters in Northeast Ethiopia

Abstract

Background

Hematological disorders are heterogeneous conditions ranging from malignant to non-malignant disorders. Hematological malignancies comprise a collection of heterogeneous conditions originating from cells of the bone marrow and the lymphatic system. Therefore, this study aimed to determine the pattern of bone marrow confirmed malignant and non-malignant hematological disorders in patients with abnormal hematological parameters.

Methods

Institutional-based cross-sectional study was conducted in Dessie town from April 2020 to June 2021. A total of 228 study participants who had abnormal hematological parameters and referred for bone marrow examination were included consecutively. About 1.5 mL of bone marrow sample and 3 mL of venous blood sample were collected for bone marrow examination, complete blood count analysis and peripheral blood morphology examination. Wright stain, Sudan black B, and Prussian blue stains were used for staining the bone marrow and peripheral blood smears. The result was expressed in mean and standard deviation and presented in texts and tables. Ratio, frequency, and percentage were used to express the magnitude of malignant and non-malignant hematological disorders.

Results

The overall prevalence of hematological malignancies among the study participants was 11.4% with 8.8% in male patients. The prevalence of hematological malignancies were 3.5% CML, 2.6% AML, 1.8% CLL and MM, 0.9% ALL and undifferentiated acute leukemia. On the other hand, 57.0% of the study participants had non-malignant hematological disorders. Regarding non-malignant hematological cases, 24.6% were erythroid hyperplasia, 10.5% aplastic anemia, 8.8% concomitant IDA and MBA, 7.0% MBA, 3.5% leukemoid reaction, 1.8% IDA, and 0.9% visceral leishmaniasis. In patients with HM, 66.7% of AML, 100% of CML and CLL, and 75% of MM patients had increased total WBC count, whereas 66.7% of AML, 62.5% of CML, 75% of CLL, and 50% of MM patients had decreased hemoglobin level. On the other hand, 66.7% of AML, and 50% of CML, ALL, and CLL patients had decreased platelet count.

Conclusion

In this study, 11.4% of the patients had hematological malignant cases, whereas 57% of the patients had non-malignant hematological cases. Therefore, in patients with hematological abnormalities and where conclusive diagnosis could not be made through clinical and other laboratory investigations, bone marrow examination should be done for definitive diagnosis, management and prognosis.

Keywords:

• hematological malignancies
• non-malignant hematological disorders
• leukemia
• anemia
• Ethiopia

Abbreviations

AL, acute leukemia; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; BME, bone marrow examination; CBC, complete blood count; CL, chronic leukemia; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; FAB, French American British; FNAC, fine-needle aspiration cytology; IDA, iron deficiency anemia; HM, hematological malignancies; MBA, megaloblastic anemia; MDS, myelodysplastic syndrome; MM, multiple myeloma; MPN, myeloproliferative neoplasms; PBM, peripheral blood morphology; RBC, red blood cell; SD, standard deviation; SOP, standard operating procedures; WBC, white blood cells; WHO, World Health Organization.

Data Sharing Statement

The authors confirmed that all the data for this manuscript are available; if someone wants to request the data they can contact the corresponding author.

Ethics and Consent Statement

The study was approved by Research and Ethics Review Committee of the College of Medicine and Health Sciences, Wollo University. A support letter was secured from Dessie zonal health office and a permission letter was obtained from the chief executive officer of the diagnostic medical laboratory. Moreover, written informed consent was taken from each study participant before conducting the investigation. This study was conducted in accordance with the declaration of Helsinki.

Acknowledgments

We would like to thank the study participants and data collectors who participated in this study. Furthermore, we would also give our heartfelt thanks to all who support and stood by our side during the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

The study did not receive any official funding.