| ObjectiveThis study of hematology synchronous bone marrow smear morphology and bone marrow biopsy slice pathologic examination compared the value of the synchronous application of the two methods in blood disease diagnosis which can improve the accuracy of diagnosis in children’s blood disease,reducing misdiagnosis and missed diagnosis.MethodsUsed synchronization to obtain specimens of bone marrow smear and bone marrow biopsy section method,compare 89 cases of children from 2014.2 to 2016.9 of Affiliated Hospital of Qingdao University of pediatrics blood outpatient and hospitalization in bone marrow cytology and bone marrow biopsy.Compared the difference between the two methods in the bone marrow hyperplasia degree and diagnosis coincidence rate.Results1.The contrast of hyperplasia of the bone marrow between bone marrow smear and bone marrow biopsies :(1)The 42 cases of the new diagnostic children with aplastic anemia(AA)all had hematology synchronous bone marrow smear morphology and bone marrow biopsy slice pathologic examination.Bone marrow smear showed that hyperplasia of the bone marrow was reducing in 29 patients,accounting for 69%.Bone marrow biopsy showed that hyperplasia of the bone marrow was reducing in 40 patients,accounting for 90.5%.Bone marrow biopsy for the evaluation of bone marrow hyperplasia degree was better than bone marrow cytology.(X2=9.82;P < 0.05).(2)The 14 children with malignant blood system diseases had hematology synchronous bone marrow smear morphology and bone marrow biopsy slice pathologic examination.Bone marrow smear showed that hyperplasia of the bone marrow was hyperactive and above in 12 cases,accounting for 85.7%,and was reducing in 2 patients,accounting for 14.3%;On the other hand,bone marrow biopsy showed that hyperplasia of the bone marrow was hyperactive and above in 13 cases,accounting for 92.9%,and was reducing in 1 patients,accounting for 7.1%.There is no statistical difference between the methods(x2=1.119;P=0.48).(3)In the 15 cases of children with Acute lymphoblastic leukemia in the maintenance phase,bone marrow smear showed that hyperplasia of the bone marrow was hyperactive and above in 10 cases,accounting for 66.7%,and was reducing in 5 patients,accounting for 33.3%;On the other hand,bone marrow biopsy showed that hyperplasia of the bone marrow was hyperactive and above in 14 cases,accounting for 93.3%,and was reducing in 1 patients,accounting for 6.7%.There is no statistical difference between the methods(x2=3.33;P=0.169).(4)In the18 cases of children with Immune thrombocytopenia(ITP),bone marrow smear showed that hyperplasia of the bone marrow was hyperactive and above in 17 cases,accounting for 94.4%,and was reducing in 1 patients,accounting for 5.6%;On the other hand,bone marrow biopsy showed that hyperplasia of the bone marrow was hyperactive and above in 14 cases,accounting for 77.8%,and was reducing in 4 patients,accounting for 22.2%.There is no statistical difference between the methods(x2=2.090;P=0.033).2.The contrast of the clinical diagnosis rate in children’s blood disease between bone marrow smear and bone marrow biopsies:(1)The rate of diagnosis of children with aplastic anemia(AA): 1).In the 42 cases of the new diagnostic children with aplastic anemia(AA),bone marrow smear was in the diagnosis of 26 cases,accounting for 61.9%.And bone marrow biopsy was in the diagnosis of 35 cases,accounting for 83.3%.Bone marrow biopsy was obviously higher in the positive rate of diagnosis than that of bone marrow cytology(X2=4.85;P < 0.05);The combination of the two methods was in the diagnosis of 41 cases,diagnosis accuracy was 97.6%.Compare with one method,the synchronous application of the two methods can significantly improve the diagnosis of children with aplastic anemia(X2=16.59 and X2=4.97;P < 0.05 both).2)Among the 42 children,18 cases whose blood reduced in one system were identified to be atypical aplastic anemia.In the 18 children with atypical aplastic anemia,bone marrow smear was in the diagnosis of 8 cases,accounting for 44.4%.And bone marrow biopsy was in the diagnosis of 16 cases,accounting for 88.9%.Bone marrow biopsy was obviously higher in the positive rate of diagnosis than that of bone marrow cytology(X2=8.00;P < 0.05).Compare with bone marrow smear,the synchronous application of the two methods can significantly improve the diagnosis of children with aplastic anemia(X2=13.846;P =0).But there was no statistical difference comparing with bone marrow biopsy(X2=2.118;P =0.486).3)Among the 42 new diagnostic children with aplastic anemia,twenty of them applied synchronous bone marrow smear morphology and bone marrow biopsy slice pathologic examination after standard treatment.In the 12 children whose blood performed to restore,bone marrow smear was consistent with clinical performance of 5 cases,accounting for 41.7%,and bone marrow biopsy was consistent with clinical performance of 11 cases,accounting for 91.7%.Bone marrow biopsy was obviously better in the evaluatation than that of bone marrow cytology(X2=6.75;P < 0.05).On the other hand in the 8 children whose hematopoietic disorders were aggravated,bone marrow smear was consistent with clinical performance of 3 cases,accounting for 37.5%,and bone marrow biopsy was consistent with clinical performance of 8 cases,accounting for 100%.Obviously bone marrow biopsy was obviously better in the evaluatation than that of bone marrow cytology(X2=7.27;P < 0.05).(2)The rate of clinical diagnosis of children with malignant blood system diseases: In the14 cases of children with malignant blood system diseases,bone marrow smear was in the diagnosis of 6 cases,accounting for 42.9%.And bone marrow biopsy was in the diagnosis of 12 cases,accounting for 85.7%.Bone marrow biopsy was obviously higher in the positive rate of diagnosis than that of bone marrow cytology(X2=5.600;P < 0.05);The combination of the two methods was in the diagnosis of 14 cases,diagnosis accuracy was 100%.Compare with one method,the synchronous application of the two methods can significantly improve the diagnosis of children’s blood diseases(X2=19.07 and X2=6.19;P < 0.05 both).(3)The rate of clinical diagnosis of clinical relapse of 15 cases of children with Acute lymphoblastic leukemia in the maintenance phase: In this study,the neutrophils recovery of 15 cases of children with Acute lymphoblastic leukemia(ALL)delayed in the maintenance phase.Before clinical relapse,hematology synchronous of bone marrow smear morphology and bone marrow biopsy slice pathologic examination were implemented,on the one hand bone marrow smear indicated early recurrence in 2 cases and the coincidence rate with clinical recurrence was 13.3%.On the other hand bone marrow biopsies indicated early recurrence in 8 cases and the coincidence rate with clinical recurrence was 53.3%.The coincidence rate with clinical recurrence of bone marrow biopsies was obviously higher than that of bone marrow cytology(X2=5.40;P < 0.05).The combination of the two methods which were applied synchronously indicated early recurrence in 14 cases and the coincidence rate with clinical recurrence was 93.3% which obviously higher than either method(X2=19.28 and X2=6.13,P < 0.05 both).(4)The rate of the diagnostic compliance of Immune thrombocytopenia(ITP): In the18 cases of children with Immune thrombocytopenia(ITP),bone marrow smear was in the diagnosis of 14 cases,accounting for 77.8%.On the other hand,bone marrow biopsy was in the diagnosis of 8 cases,accounting for 44.4%.Bone marrow biopsy was significantly lower than bone marrow cytology,the difference was statistically significant(X2=6.41;P < 0.05).The synchronous application of bone marrow smear and bone marrow biopsies was in the diagnosis of 17 cases,accounting for 94.4%,comparing with one method,the synchronous application of the two methods can significantly improve the diagnosis of ITP(X2=8.86 and X2=25.07,P < 0.05 both).3.Cytology changes of bone marrow smear and bone marrow biopsy in children’s blood disease:(1)Cytology changes of bone marrow smear and bone marrow biopsy in children with aplastic anemia: Bone marrow smear indicated that among the 42 cases of AA children,the proportion of lymphocytes increased in 37 cases,and 36 non-hematopoietic cells were found,and 28 cases of macrokaryotic cells were reduced or absent.While bone marrow biopsy indicated that the proportion of lymphocytes increased in 40 cases and 38 cases of macrokaryotic cells were reduced or absent.(2)Cytology changes of bone marrow smear and bone marrow biopsy in children with primary diagnosis of malignant blood system disease: No abnormality was found in both the bone marrow smear and bone marrow biopsy in 5 patients with lymphoma.In the three children with chronic myelogenous leukemia(CML),bone marrow smear indicated that less than 5 percent of the original juvenile cells were found,and the proportion of their departments and their divisions were normal.While bone marrow biopsy indicated that less than 5 percent of the original juvenile cells were found in the 3cases of CML,and reticular fibers(+ +)in two cases,reticular fiber(+)in one cases.In the 6 cases of MDS bone marrow smear indicated that pathological hematopoietic was found in 5 children,along with morphological changes such as the supergiant points eosinophils distortion,giant hairy red cells,single cylinder megakaryocyte and so on.Bone marrow biopsy indicated pathological hematopoiesis was found in 6 children with MDS,in which two cases were found in abnormal localization of immature precursors(ALIP).Bone marrow biopsy indicated that the original juvenile cells were less than 20% but greater than 5% in three cases of MDS,and less than 5 percent in other three cases.Among the 6 MDS,immunohistochemical indicated CD34 +,CD117 + in 3 children and CD34 + in one child,while CD61 nuclear macronuclei was found in 3 cases;All six cases of MDS had a different degree of mesh fiber positive.(3)Cytology changes of bone marrow smear and bone marrow biopsy in children with acute lymphoblastic leukemia in the maintenance phase: In the 15 cases,bone marrow smear indicated that the proportion of primitive juvenile cells was greater than 25% in 2 cases and the nuclear dyeing was dispersed and the nucleoli were numerous.While in other 13 children the proportion of primitive juvenile cells were less than 5% and the nucleation was denser.Bone marrow smear indicated that in the 15 cases,11 cases were significantly suppressed in Grain,6 cases in red blood hematopoietic and 4 cases in megakaryocyte.On the other hand bone marrow biopsy showed that the diffuse proliferation of the medium-sized lymphocyte cells in 8 cases of the 15 cases,8 cases of immunohistochemical showed CD34(+)TDT(+).Bone marrow biopsy indicated that in the 15 cases,14 cases were significantly suppressed in Grain,8 cases in red blood hematopoietic and 6 cases in megakaryocyte.(4)Cytology changes of bone marrow smear and bone marrow biopsy in children with ITP: Bone marrow smear indicated that among the 18 cases of ITP the number of megakaryocytes is normal in 6 cases and increased in 12 cases.Bone marrow smear indicated that among the 18 cases of ITP macrokaryotic cells mature,and the platinoid was reduced in 14 cases.Bone marrow smear indicated that among the 18 cases of ITP platelets were scattered in the form of normal form in 14 cases and large platelets were found in 2cases.Bone marrow biopsy indicated that among the 18 cases of ITP the number of megakaryocytes is normal in 10 cases and increased in 8 cases along with macrokaryotic cells mature.Conclusion1.Bone marrow cytology and bone marrow biopsy pathologic examination have their own advantages in the corresponding diseases.The advantage of the former is to observe the cellular morphological changes,while the latter is more better at observing the structure and judging the bone marrow hyperplasia degree.2.The children with acute lymphoblastic leukemia(ALL)whose white blood cells reducing persistently in the maintenance phase,need bone marrow biopsy while bone marrow cytology application.3.The synchronous application of bone marrow cytology and bone marrow biopsy pathologic examination is helpful to the diagnosis of secondary thrombocytopenia and reduce misdiagnosis of ITP.4.The synchronous application of bone marrow cytology and bone marrow biopsy,pathologic examination can significantly improve the rate of correct diagnosis of children’s blood diseases and reduce misdiagnosis and missed diagnosis.The synchronous application of the two methods has important significance in the blood in pediatric clinical diagnosis. |
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