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Title: Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context.
Austin Authors: Hong, Frank S;Fox, Lucy C;Chai, Khai Li;Htun, Kay;Clucas, Danielle;Morgan, Susan;Cole-Sinclair, Merrole F;Juneja, Surender
Affiliation: Department of Laboratory Haematology, Austin Health, Heidelberg, Victoria, Australia
Alfred Health Prahran, Victoria
St Vincent's Hospital Melbourne Fitzroy, Victoria
Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Laboratory Haematology, St Vincent's Hospital Melbourne Fitzroy, Victoria
Laboratory Haematology, Alfred Health Prahran, Victoria
The Royal Melbourne Hospital, Parkville, Victoria, Australia
Issue Date: 2019
Date: 2018-10-22
Publication information: Internal Medicine Journal 2019; 49(7): 850-854
Abstract: Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known HIV infection and previously diagnosed connective tissue diseases were excluded. Seventy-three patients were included in the study. Fifty-one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B-cell lymphoma had normal BMBs. FDG-PET was helpful in making a diagnosis in eight (25%) out of 32 patients. Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations such as FDG-PET, may be more likely to help establish a definitive diagnosis. This article is protected by copyright. All rights reserved.
DOI: 10.1111/imj.14147
ORCID: 0000-0001-8331-2154
Journal: Internal Medicine Journal
PubMed URL: 30350441
Type: Journal Article
Subjects: bone marrow examination
clinical laboratory diagnoses
fever of unknown origin
positron-emission tomography
Appears in Collections:Journal articles

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