Bushra Anwar,* Khalid Hassan ** and Naghmi Asif **
*. Rawal Institute of Health Sciences
**. Islamabad Medical and Dental College, Islamabad
Objective: To see the diagnostic utility of bone marrow examination in patients of chronic liver disease referred
for evaluation of hematological derangements.
Material and methods: The study was conducted from July 2009 to July 2011 at the Department of Pathology,
Pakistan Institute of Medical Sciences (P.I.M.S), Islamabad. A total of 75 diagnosed cases of Hepatitis C induced
chronic liver disease, referred from different departments of PIMS with various indications for bone marrow
examination were included in the study. All these cases were qualitative PCR-positive for HCV-RNA. Patient who
had already received or were on anti -viral therapy were excluded. Routine blood cell counts were done and later
all the patients were subjected to bone marrow examination. Data was entered on SPSS version 16 and statistically
Results: In a total of 75 patients of chronic liver disease age ranged from 15 years to 76 years with a mean age of
43 years. The male to female ratio was 0.92:1. The main indications of bone marrow examination in the current
study were cytopenias. Hypersplenism was the commonest finding in our patients, observed in 34.7% cases
followed by Idiopathic Thrombocytopenic Purpura (22.6%), anemia of chronic disease (13.3%), hypoplastic bone
marrow (5.3%), bone marrow aplasia (4%) and megaloblastic marrow (5.3%). Iron deficiency was the main
diagnosis in 2 cases but it was observed in association with many other conditions like hypersplenism, Idiopathic
Thrombocytopenic Purpura, reactive bone marrow, hypoplastic bone marrow and when combined, iron
deficiency was found in 28(37.3%) cases. Similarly megaloblastic change was also found in association with other
factors and in total was observed in 8 (10.7%) cases.
Conclusion: Bone marrow examination in Hepatitis C Virus infected patients can be a valid test for hematologic
evaluation, especially for patients with severe pancytopenia and /or sudden alterations in peripheral cell counts.
Key words: Chronic liver disease, HCV, pancytopenia, cytopenias