J Clin Outcomes Manage
Bone marrow biopsy to evaluate cytopenia in the ICU: an analysis of 21 patients
Marinella MA, Markert RJ
Abstract Objective: To describe the characteristics and outcome of intensive care unit (ICU) patients who underwent bone marrow biopsy. Design: Medical record review and analysis. Setting: 570-bed community teaching hospital. Participants: 21 patients who underwent bone marrow biopsy during their ICU course. Measurements: Reasons for and results of bone marrow analysis, treatments specifically based on results of bone marrow analysis, clinical variables (use of mechanical ventilation and vasopressors at the time of biopsy, and outcome during hospitalization), and laboratory values obtained within 24 hours of biopsy (hemoglobin, total leukocyte count, platelet count, absolute lymphocyte count [ALC], albumin, and creatinine). Results: The mean age (± standard deviation) was 61.1 ± 15.1 years, and most biopsies were obtained to investigate anemia or thrombocytopenia in the setting of sepsis, respiratory failure, or primary hematologic or malignant disease. Eleven patients (52.4%) survived. Results of bone marrow analysis were abnormal in 17 (81%) patients, and of these 11 had a malignant process, typically hematopoietic, discovered on histopathologic examination. There was no difference in survival of ICU patients with malignant versus nonmalignant bone marrow findings (P = 0.410). However, all 5 patients who received vasopressors at the time of biopsy died while in the ICU. None of the 11 patients who survived received vasopressors, but 5 of 10 patients who died received vasopressors (P = 0.012). There were clinically meaningful lower mean values for serum albumin and ALC in patients who died, but the differences were not statistically significant. Patients who received vasopressors exhibited a markedly lower platelet count compared with patients who did not receive vasopressors (27,660 cells/mm3 versus 110,750 cells/mm3; P = 0.032). Conclusion: Bone marrow biopsy is an underutilized procedure in the ICU population, with frequently abnormal results that lead to specific therapies. However, vasopressor use portends a high mortality, and bone marrow biopsy may not be warranted in these patients.
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