The role of trephine needle bone marrow biopsy in the evaluation of various haematological and non-haematological diseases At Kenyatta National Hospital, Nairobi
This is a descriptive retrospective and prospective study of 101 patients admitted to Kenyatta National Hospital (KNH) between 1st October, 1985 and 30th January, 1990 and had bone marrow examination done by aspiration and trephine needle biopsy. At KNH trephine needle bone marrow (TNBM) biopsy has been performed over the years when aspiration results in 'dry tap'. It is only available for the use by a few specialists (haematologists) and it is rarely performed in staging malignant lymphomas or as a routine diagnostic technique in various other diseases. The study was done to evaluate the role of the technique in patient care at this hospital. The relevant data and the diagnostic outcome of 50 patients admitted to the hospital between 1st October, 1985 and 30th June, 1989 were collected retrospectively. Trephine needle biopsies were performed by the investigator on 51 patients during the last 7 months of the study. Data collected included: the age and sex, the indications for bone biopsy, the quality of the specimen, the reporting format and the final diagnosis on the trephine biopsies. The 101 patients studied were between 2 and 75 years of age. The mean age was 23.9 years. There were 62 males and 39 females. A 'dry tap' aspirate, the commonest indication for TNBM biopsy was reported in 37 (36.6%) cases. In twelve cases, the aspirate and needle biopsy were performed at the same time using the same needle. Ten of these were in the staging of malignant lymphomas. Good or satisfactory specimens were obtained in at least 86% of the biopsies performed. Aplastic anaemia, the commonest abnormality detected was found in 28 (27.7%) of the patients studied. A review of the reporting format showed that in only 20% cases in the retrospective study was a full report of the biopsy given by the haematologist. This study shows that TNBM biopsy is a simple and safe procedure yielding a good or satisfactory specimen in most instances. The biopsy will most likely provide a diagnosis when bone marrow aspirate fails due to 'dry tap' or scanty yield. The procedure may be of value in routine investigation of various diseases such as aplastic anaemia and in staging of malignant lymphomas although larger studies need to be done in this area (only ten cases in this study). A standard format should be formulated and adhered to by haematologists and pathologists reporting on the TNBM biopsies in this hospital.