Clin Pediatr Hematol Oncol.  2014 Oct;21(2):128-134. 10.0000/cpho.2014.21.2.128.

Lower Diagnostic Value of Bone Marrow Biopsy in Children with Fever of an Unknown Origin

Affiliations
  • 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
  • 2Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.

Abstract

BACKGROUND
Diagnostic value of Bone marrow (BM) biopsies for fever of unknown origin (FUO) remain controversial and BM biopsies are difficult to perform in young patients. Our study aimed to elucidate the diagnostic yield of BM biopsies in FUO patients of all age, particularly for diagnosing hematological malignant diseases.
METHODS
The medical records of 150 patients, hospitalized between January 1, 2008 and June 30, 2013, who underwent BM biopsies were evaluated to determine the cause of FUO. FUO was defined as fever (38.3degrees C, 101) either on several occasions during the 3 hospital days without a clear cause, after 1 week of invasive investigation, or after 3 outpatient visits. BM-specific diagnoses included those determined by BM biopsies (i.e., leukemia, lymphoma, myeloproliferative disease, myelodysplastic syndrome, aplastic anemia, and hemophagocytic lymphohistiocytosis).
RESULTS
The final diagnoses of 24 patients (16%) were determined by BM biopsies; the majority included hematologic diseases and malignant neoplasms. Low hemoglobin levels, thrombocytopenia, bicytopenia, increased Lactate dehydrogenase (LDH) and ferritin levels, and ultrasonographic/computed tomographic abnormalities were significant risk factors (P<0.05). The young patient group (<18 years old) was safer from the tendency of BM biopsy diagnosis compared to adult patient group (>40 years old).
CONCLUSION
Some laboratory abnormalities were related to the BM biopsy diagnostic yield. Furthermore, pediatric age was an important factor for deciding to do not perform excessive BM biopsies in FUO cases.

Keyword

Fever of unknown origin; Bone marrow biopsy; Hematological malignancy; Age; Predictive factors

MeSH Terms

Adult
Anemia, Aplastic
Biopsy*
Bone Marrow*
Child*
Diagnosis
Ferritins
Fever of Unknown Origin
Fever*
Hematologic Diseases
Hematologic Neoplasms
Humans
L-Lactate Dehydrogenase
Leukemia
Lymphoma
Medical Records
Myelodysplastic Syndromes
Outpatients
Risk Factors
Thrombocytopenia
Ferritins
L-Lactate Dehydrogenase
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