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\title{Spectrum of Disorders Diagnosed by Bone Marrow Aspiration}
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             \author[1]{Dr. Aparajita  Tomar}

             \author[2]{Dr. Vibha  Trichal}

             \author[3]{Dr. RPS  Chauhan}

             \affil[1]{  bundelkhand medical college, sagar, madhya pradesh}

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\date{\small \em Received: 15 December 2014 Accepted: 3 January 2015 Published: 15 January 2015}

\maketitle


\begin{abstract}
        


Aims and Objectives: To identify and analyse the most common hematological disorders diagnosed by doing bone marrow aspiration in a particular group of patients.Material and Method: Bone marrow aspiration was done from Manubrium of the Sternum after injecting 2% xylocaine to the part. Bone marrow smears were prepared and stained with Leishman stain along with the simultaneous staining of the peripheral smears. A complete hemogram including Hb%, PCV, Red cell indices, platelet count, total leucocyte count and differential leucocyte count was also done by Automated cell counter. Finally, the bone marrow and peripheral smears were examined manually under oil immersion. Conclusion:In this study it was found that the most frequently diagnosed hematological disorders on bone marrow aspiration are Megaloblastic and Dimorphic anemias followed by Acute Myeloid and Acute Lymphoblastic Leukemias. Hematological disorders are more common in early adulthood. commonest leukemia in adults and children is Acute Myeloid Leukemia, AML and Acute Lymphoblastic Leukemia, ALL respectively with overall prevalence of leukemias being more in adults.

\end{abstract}


\keywords{bone marrow aspiration, anemia, leukemia.}

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\let\tabcellsep& 	 	 		 \par
some abnormality in the peripheral blood smears. OPD patients on clinical suspicion of a hematological disorder by the consultant incharge were also included in the study group after obtaining the detailed history, clinical examination and all relevant investigations. Patients with highly increased bleeding time and clotting time were deterred. 
\section[{II. Procedure}]{II. Procedure}\par
The guard on the aspiration needle was adjusted and with the boring movement, needle (salah needle) was passed perpendicularly into the cavity. After piercing the skin and the subcutaneous tissue when the needle point reached the periosteum, the needle was pushed with a boring motion into the cavity and the termination point was achieved when there was loss of resistance. Stilette was removed and a 10 ml dispovan syringe was attached to the needle to suck the marrow contents. Not more than 0.3 ml of marrow fluid was sucked in a single aspiration. Immediately, 6-8 good marrow smears were made and dried quickly with the help of a hair drier. Simultaneously, 2-3 peripheral blood smears were also made. The slides were numbered with a diamond pencil. Two marrow smears and one peripheral blood smear were taken for leishman staining while the rest of the unstained smears, after being fixed in methanol were wrapped in an aluminium foil and kept in a dry place for future use. 
\section[{b) Leishman Staining of Slides}]{b) Leishman Staining of Slides}\par
Bone marrow smears and the peripheral blood smear were placed on a staining rack and leishman stain was put drop by drop on the film so as to cover it completely. After 2 minutes, double the volume of 
\section[{S a) Bone Marrow Aspiration}]{S a) Bone Marrow Aspiration}\par
Patient and his attendants were told about the entire procedure and a written consent was taken. Complete patient preparation (xylocaine sensitivity testing, cleaning and draping) was done prior to the bone marrow aspiration. The skin over the sternum was cleaned with 70\% ethyl alcohol. The skin, subcutaneous tissue and the periosteum overlying the manubrium was infiltrated with 1-1.5 ml of 2\% xylocaine. Two minutes were given to achieve the effect of anaesthesia. In case of small children and uncooperative patients, sedation with diazepam was used. The site of puncture of the manubrium was opposite to the second intercostal space and slightly to one side of the midline.  buffered water was added and the two were mixed together with the help of a dropper. After 20 minutes, slides of peripheral smear were washed under the running tap water and the scum was drained off while bone marrow smears were washed after 30 minutes. Back side of the slides was wiped off with a clean and dry filter paper. The slides were kept in a vertical position to drain and dry. The slides were now ready for the microscopic examination. 
\section[{c) Reporting of Bone Marrow Smears}]{c) Reporting of Bone Marrow Smears}\par
Bone marrow as well as peripheral smears were first scanned with scanner (4X lens) followed by the examination under low power(10X), high power(40X) and oil immersion lenses(100X) respectively. The final reports were dispatched in the prescribed format only.  
\section[{PERCENTAGE OF CASES IN EACH AGE GROUP}]{PERCENTAGE OF CASES IN EACH AGE GROUP} 
\section[{IV. Conclusion}]{IV. Conclusion}\par
In this study, we found that on bone marrow aspiration the most frequently diagnosed haematological disorders 1 are Anemias 9 . Amongst the anemias, the commonest one are the Megaloblastic anemias \hyperref[b3]{4,}\hyperref[b5]{6,} {\ref 10} and those showing Dimorphic blood picture. Acute Leukemias 2,3,5,7,8 occupy the second position in the list including the Acute Myeloid Leukemias and Acute Lymphoblastic Leukemias with overall prevalence of leukemias being more in adults as compared to children. Hematological disorders are more common during childhood period and in the early adulthood. Commonest Leukemia in adults is Acute Myeloid Leukemia. The most common clinical presentation of Acute Leukemias is Pallor and Fever while Anemias present clinically with Pallor and Fatigue. 
\section[{V. Acknowledgement}]{V. Acknowledgement}\par
Smt. Annapurna Tomar, Dr. R.K Nigam and the entire staff of the department of pathology, Gandhi Medical College, Bhopal, M.P.\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}C}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-3.png}
\caption{\label{figure3}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{no} \par 
\begin{longtable}{P{0.06596452328159645\textwidth}P{0.597450110864745\textwidth}P{0.06407982261640799\textwidth}P{0.12250554323725056\textwidth}}
\tabcellsep \multicolumn{2}{l}{2 : Spectrum of Disorders}\tabcellsep \\
\multicolumn{2}{l}{S.No Disorder}\tabcellsep Total\tabcellsep Percentage (\%)\\
1\tabcellsep Megaloblastic Anemia\tabcellsep 59\tabcellsep 43.7\\
2\tabcellsep Dimorphic Anemia\tabcellsep 18\tabcellsep 13.3\\
3\tabcellsep Acute Myeloid Leukemia\tabcellsep 13\tabcellsep 9.6\\
4\tabcellsep Idiopathic Thrombocytopenic Purpura\tabcellsep 13\tabcellsep 9.6\\
5\tabcellsep Hypoplastic Marrow\tabcellsep 11\tabcellsep 8.1\\
6\tabcellsep Acute Lymphoblastic Leukemia\tabcellsep 09\tabcellsep 6.6\\
7\tabcellsep Plasma Cell Disorder\tabcellsep 03\tabcellsep 2.2\\
8\tabcellsep Myeloproliferative Disorder\tabcellsep 03\tabcellsep 2.2\\
9\tabcellsep Lymphoproliferative Disorder\tabcellsep 02\tabcellsep 1.5\\
10\tabcellsep Chronic Lymphocytic Leukemia\tabcellsep 01\tabcellsep 0.74\\
11\tabcellsep Myelodysplastic Syndrome\tabcellsep 01\tabcellsep 0.74\\
12\tabcellsep Leishmaniasis\tabcellsep 01\tabcellsep 0.74\\
13\tabcellsep Hypersplenism\tabcellsep 01\tabcellsep 0.74\\
Total\tabcellsep \tabcellsep 135\tabcellsep 100.0\end{longtable} \par
 
\caption{\label{tab_0}Table no .}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{no} \par 
\begin{longtable}{P{0.6790760869565217\textwidth}P{0.01154891304347826\textwidth}P{0.053125\textwidth}P{0.09701086956521739\textwidth}P{0.009239130434782607\textwidth}}
\multicolumn{4}{l}{III. Observation and Discussion}\tabcellsep \\
\multicolumn{4}{l}{1 : Indications for Bone Marrow Examination}\tabcellsep \\
INDICATION\tabcellsep \tabcellsep \tabcellsep CASES\tabcellsep \\
\tabcellsep \tabcellsep No.\tabcellsep \%\tabcellsep \\
Anemia Under Evaluation\tabcellsep \tabcellsep 62\tabcellsep 46.0\tabcellsep \\
\multicolumn{2}{l}{Pancytopenia Under evaluation}\tabcellsep 28\tabcellsep 20.7\tabcellsep \\
Suspected Leukemia\tabcellsep \tabcellsep 14\tabcellsep 10.4\tabcellsep \\
Thrombocytopenia\tabcellsep \tabcellsep 12\tabcellsep 8.9\tabcellsep \\
\multicolumn{2}{l}{Hepatosplenomegaly Under evaluation}\tabcellsep 04\tabcellsep 3.0\tabcellsep \\
Pyrexia Under Evaluation\tabcellsep \tabcellsep 02\tabcellsep 1.5\tabcellsep \\
Others\tabcellsep \tabcellsep 13\tabcellsep 10.0\tabcellsep \\
Total\tabcellsep \tabcellsep 135\tabcellsep 100.0\tabcellsep \\
\multicolumn{4}{l}{INDICATIONS FOR BONE MARROW}\tabcellsep \\
\multicolumn{2}{l}{ASPIRATION}\tabcellsep \tabcellsep \tabcellsep \\
46 \%\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
20.7\%\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
10.4\%\tabcellsep 8.9\%\tabcellsep 3\%\tabcellsep 1.5\%\tabcellsep 10\%\end{longtable} \par
 
\caption{\label{tab_1}Table no .}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{no3} \par 
\begin{longtable}{P{0.6048076923076923\textwidth}P{0.24519230769230765\textwidth}}
\multicolumn{2}{l}{Age (Yrs) Percentage}\\
0-20\tabcellsep 41.5\\
21-40\tabcellsep 33.3\\
41-60\tabcellsep 22.2\\
>60\tabcellsep 3.0\end{longtable} \par
 
\caption{\label{tab_2}Table no . 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{no4} \par 
\begin{longtable}{P{0.08888888888888889\textwidth}P{0.15555555555555553\textwidth}P{0.11666666666666667\textwidth}P{0.08611111111111111\textwidth}P{0.40277777777777773\textwidth}}
\tabcellsep \multicolumn{4}{l}{SPECTRUM OF DISORDERS Megaloblastic Anemia}\\
\tabcellsep 1\%\tabcellsep \tabcellsep \\
2\%\tabcellsep 2\% 1\% 1\%\tabcellsep 1\% 1\%\tabcellsep \tabcellsep Dimorphic Anemia\\
6\%\tabcellsep \tabcellsep \tabcellsep \tabcellsep Acute Myeloid Leukemia\\
8\%\tabcellsep \tabcellsep \tabcellsep 44\%\\
10\%\tabcellsep \tabcellsep \tabcellsep \tabcellsep Idiopathic Thrombocytopenic\\
10\%\tabcellsep \tabcellsep 13\%\tabcellsep \tabcellsep Purpura Hypoplastic Marrow\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep Acute Lymphoblastic\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep Leukemia\\
50\tabcellsep \tabcellsep \tabcellsep \\
40\tabcellsep \tabcellsep \tabcellsep \\
30\tabcellsep \tabcellsep \tabcellsep \\
20\tabcellsep \tabcellsep \tabcellsep \\
10\tabcellsep \tabcellsep \tabcellsep \\
0\tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{2}{l}{0-20}\tabcellsep 21-40\tabcellsep 41-60\tabcellsep >60\\
\tabcellsep \tabcellsep Age (Yrs)\tabcellsep Males (\%)\tabcellsep Females (\%)\\
\tabcellsep \tabcellsep 0-20\tabcellsep 57.1\tabcellsep 42.9\\
\tabcellsep \tabcellsep 21-40\tabcellsep 53.3\tabcellsep 46.7\\
\tabcellsep \tabcellsep 41-60\tabcellsep 70\tabcellsep 30\\
\tabcellsep \tabcellsep >60\tabcellsep 25\tabcellsep 75\end{longtable} \par
 
\caption{\label{tab_3}Table no . 4 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[ AGE(Yrs) AND SEX(%) DISTRIBUTION OF CASES]{b7}\label{b7} 	 		\textit{},  	 	 		\textit{AGE(Yrs) AND SEX(\%) DISTRIBUTION OF CASES}  		 	 
\bibitem[Khan et al. (1991)]{b2}\label{b2} 	 		\textit{},  		 			M Q Khan 		,  		 			A S Shivarudrappa 		,  		 			S El-Bialy 		,  		 			M Z Khawagi 		,  		 			M Mofarreh 		.  	 	 		\textit{Leukemia cases in Central Hospital}  		1991 Feb. 89  (2)  p. .  	 	 (J Indian Med Assoc.) 
\bibitem[Khan et al. ()]{b3}\label{b3} 	 		‘Association of Megaloblastic Anemia with peripheral cytopenias’.  		 			S Khan 		,  		 			F Raziq 		,  		 			H Qureshi 		.  	 	 		\textit{JPMI}  		2009. 23  (01)  p. .  	 
\bibitem[Mukiibi et al.]{b6}\label{b6} 	 		\textit{Leukemia at Queen},  		 			J M Mukiibi 		,  		 			C M Nyirendra 		,  		 			J O Adewuyi 		,  		 			E L Mzula 		,  		 			E D Magombo 		,  		 			E M Mbvundula 		.  		 	 
\bibitem[Vda De Torregrosa et al. ()]{b5}\label{b5} 	 		‘Megaloblastic anemia in infancy’.  		 			Mercedes V Vda De Torregrosa 		,  		 			Margarita Caceres De 		,  		 			Costas 		.  	 	 		\textit{Clinical Pediatrics}  		1964. 3  (6)  p. .  	 
\bibitem[Sharmila et al. (2008)]{b4}\label{b4} 	 		‘Neoplastic Lesions in Bone Marrow : a 10 year study in a Teaching Hospital’.  		 			Laishram Sharmila 		,  		 			Shimray Rachel 		,  		 			A Sharma 		,  		 			Pukhrambam Barindra 		,  		 			Gayatri 		,  		 			A Singh 		,  		 			Meena 		,  		 			L Durlav Sharma 		,  		 			Chandra 		.  	 	 		\textit{Journal, Indian Academy Of Clinical Medicine}  		July-September, 2008. 9  (3)  p. .  	 
\bibitem[Al-Ghazaly et al. (2006)]{b0}\label{b0} 	 		‘Pattern of haematological diseases diagnosed by bone marrow examination in Yemen: a developing country experience’.  		 			J Al-Ghazaly 		,  		 			A H Al-Selwi 		,  		 			M Abdullah 		,  		 			A K Al-Jahafi 		,  		 			Al-Dubai 		,  		 			W 		,  		 			Al-Hashdi 		,  		 			A 		.  	 	 		\textit{Clin Lab Haematol}  		2006 Dec. 28  (6)  p. .  	 
\bibitem[Cartwright et al. (2002)]{b1}\label{b1} 	 		‘Sex ratios and the risks of haematological malignancies’.  		 			R A Cartwright 		,  		 			K A Gurney 		,  		 			A V Moorman 		.  	 	 		\textit{Br. J Haematol}  		2002 Sep. 118  (4)  p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
