The Role of Bone Marrow Biopsy in Mild Anemia of Older Patients

Objective: Unexplained Anemia(UEA) cases may require Bone Marrow Aspiration(BMA) and Bone Marrow Biopsy (BMB) for diagnostic purposes.These procedures are performed interventionally and may lead to various complications.In our study, we planned to investigate the necessity of these procedures in UEA cases with mild anemia and grade 1 anemia with Hemoglobin (Hb) level between 10-12 g/dL.Methods: Our study is retrospective and patients diagnosed with UEA who applied to the hematology outpatient clinic were included in the study.BMA and BMB results, as well as physical examination results and all laboratory findings of 40 AA patients over the age of 50 with Hb of 10-12 g/dL were examined.Peripheral smears and bone marrow storage iron of all cases were examined.Presence of bistopenia/pancytopenia, splenomegaly, dysplastic findings, and cases of anemia with a known and obvious cause were excluded from the study.Results: When the results of the cases evaluated due to AA were examined, malignant or non-malignant hematological disease was not found.In the patient group aged 44 and over, Anemia of Chronic Disease (ACD) ranked first with 62.5%, while Iron Deficiency Anemia (IDA) ranked second with 37.5%. Conclusion:As a result; In cases of UEA, grade 1 anemia, Hb 10-12 g/dL, detailed physical examination, detailed system interrogation, imaging methods and peripheral smear show the importance of laboratory examinations.Our study results suggest that BMA and BMB examinations are not an absolute necessity in this patient group if anamnesis, physical examination and correct tests are performed.Current guidelines emphasize the need to perform BMA and BMB in UEA cases.Hb<10 g/dL is accepted as real and significant anemia.Additionally, findings such as the presence of dysplasia and bistopenia/pancytopenia are significant findings for Myelodysplastic Syndrome(MDS) and Aplastic Anemia.Our study shows that when these findings are excluded in patients with Grade 1 anemia, a differential diagnosis of anemia can be made without BMA and BMB.