Implementation of Bone Marrow Aspiration and Trephine Biopsy Done for Pediatric Patients at Tikur Anbessa Specialized Hospital, A Cross-Sectional Study
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Date
2025-04-11
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Addis Ababa UNiversity
Abstract
Background: Bone marrow is a viscous tissue that resides in the confines of bones and houses
the vitally important pluripotent stem cells. [1] The bone marrow aspirate and Trephine biopsy
is an important medical procedure for the diagnosis of hematologic malignancies and other
diseases, and for the follow‐up evaluation of patients undergoing medical therapy.[2] It is
carried out principally to permit cytological assessment but also for immunophenotypic,
cytogenetic, molecular genetics, and other specialised investigations.[3] Depending on the type
of iatrogenic injury, the procedure may have its side effects and various complications.[4]
Individual factors such as age, comorbid conditions, and procedure factors such as aspirate
volume significantly affected the yield of BMAT. [5] The final report of bone marrow aspiration
and biopsy plays a major role in management planning of each patient.
Objectives: To assess the diagnostic outcome of BMAT and factors affecting outcome of
procedure done for paediatrics patients at Tikur Anbessa Specialized Hospital
Methods: The study design was a cross-sectional study with data collection done
prospectively; it was be carried out at Addis Ababa University, College of Health Sciences,
Paediatrics and Child Health Department. Simple random sampling was used to select patients
who fulfilled eligibility criteria. A trained data collector used a questionnaire, and a check list
to collect data from chart review, during procedure and collection of pathology report. Data
was entered into SPSS version 25.0 and cleaned. Analysis included determining the outcome
from the final pathology report by percentage. Fidelity was analyzed and presented with
percentage. Factors affecting outcome were analyzed using SPSS software, with multivariate
analysis.
Results A total of 108 sample size was included in this study. 49.1% were 5-10 years old,
medean age of 6 years. 13% presented with abdominal swelling, followed by cough and neck
swelling, each 11%. This study found a 57.5 % fidelity in application of the standard of
procedure. The gaps identified are in having a complete blood count before procedure (64%),
getting informed consent (86%), explaining the procedure (53.7%), quantity of smear slides
(), technique of smear slides (10%), same incision for BMAT (70%), same needles used for
BMAT (100%), and biopsy core length (100%). The diagnostic outcome was poor in 12% and
good in 88%. In multivariate regression analysis, Duration of illness (1-3 months) increased
poor outcome odds by 10.8 times (AOR=10.8, 95%CI=1.94, 24.55). Increased platelet counts
increased poor outcome odds by 12.1 times (AOR=12.1,95%CI=1.25, 118.59). Decreased
hemoglobin levels reduced poor outcome odds by 84% (AOR=0.15,95%CI=0.012, 0.66).
Conclusion- Significant factors affecting BMAT outcomes included patient age, nutritional
status, duration of illness, and pre-procedure hematologic parameters. The lack of a locally
developed Standard Operating Procedure (SOP) contributed to variability in procedural
techniques and diagnostic accuracy. This research underscores the need for enhanced training
and improved procedural adherence to optimize BMAT effectiveness.
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Keywords
Implementation of Bone Marrow Aspiration, Trephine Biopsy, Pediatric Patients