Predictive parameters for a diagnostic bone marrow biopsy specimen in the work-up of fever of unknown origin.
OBJECTIVE
To determine the role of bone marrow biopsy (BMBX), performed in association with comprehensive blood and imaging tests, in the evaluation of patients with fever of unknown origin (FUO).


METHODS
We reviewed the medical records of 475 hospitalized patients who underwent BMBX in our medical center from January 1, 2005, to April 30, 2010. We identified 75 patients who fulfilled the accepted classic Petersdorf criteria for FUO. All patients underwent in-hospital investigation for fever, including chest and abdominal computed tomography.


RESULTS
In 20 patients (26.7%), BMBX established the final diagnosis. Sixteen patients had hematologic disorders, including 8 patients with non-Hodgkin lymphoma, 2 with acute leukemia, 1 with multiple myeloma, 1 with myelodysplastic syndrome, and 4 with myeloproliferative disorders. The remaining patients with diagnostic BMBX specimens had solid tumors (2 patients), granulomatous disease (1 patient), and hemophagocytic syndrome (1 patient). Multivariate analysis revealed the following as the significant positive predictive parameters for a diagnostic BMBX specimen: male sex (odds ratio [OR], 7.35; 95% confidence interval [CI], 1.19-45.45), clinical lymphadenopathy (OR, 21.98; 95% CI, 1.97-245.66), anemia (OR, 2.21; 95% CI, 1.28-3.80), and increased lactate dehydrogenase levels (OR, 1.003; 95% CI, 1.001-1.006).


CONCLUSIONS
Bone marrow biopsy is still a useful ancillary procedure for establishing the diagnosis of FUO, particularly if used in the appropriate clinical setting. Clinical and laboratory parameters associated with hematologic disease are predictive of a diagnostic BMBX specimen in patients with FUO.
Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sharon
S
Ben-Baruch
Jonathan
J
Canaani
Rony
R
Braunstein
Chava
C
Perry
Jonathan
J
Ben-Ezra
Aaron
A
Polliack
Elizabeth
E
Naparstek
Yair
Y
Herishanu
D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000209:etiology; D006402:Hematologic Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity