Bone Marrow Examination at Tertiary Care Center: A Four-Year Experience Highlighting Diagnostic Trends and Specimen Adequacy

Background: Bone marrow (BM) examination is a cornerstone in the diagnosis, staging, and monitoring of hematologic and systemic disorders. Its diagnostic yield is influenced by both procedural execution and clinical context. Objective: To analyze the indications, diagnostic outcomes, and specimen quality of bone marrow examinations conducted over four years in the hematology department of a tertiary care hospital. Methods: A retrospective cross-sectional study was conducted in the Hematology Department of Liaquat National Hospital, Karachi, analyzing 1,162 BM procedures performed between January 2020 and December 2023. Data were extracted from BM reports, procedure forms, and trephine slides. Incomplete records were excluded. Descriptive analysis was conducted using IBM SPSS (version 20). Results: Among 1,162 procedures, 728 (62.6%) were performed in males and 434 (37.3%) in females, with a mean patient age of 43.8 years ± 20.24. The majority were conducted by postgraduate trainees (year 2: 443; 38.1%, year 3: 385; 33.1%) under local anaesthesia (1,069; 92.0%). Non-staging indications accounted for 962 (82.8%) cases, with acute leukaemia being the most common. Malignancies were diagnosed in 484 (41.6%) cases, predominantly acute leukaemia. Among benign disorders (250; 21.5%), Immune thrombocytopenia was most frequent, followed by aplastic anaemia and hypoplastic marrow. Despite adequate sampling, 95 (8.2%) cases remained inconclusive. BM aspirates were particulate in 948 (81.6%) cases, while 881 (75.8%) trephine biopsies met the WHO-recommended length. Conclusion: BM examination remains a vital diagnostic tool in a wide array of hematologic and systemic conditions. High specimen adequacy and diverse diagnostic yield underscore procedural competence and the value of training programs in tertiary care settings.