[The role of bone marrow pathology in diagnosis and differential diagnosis of refractory cytopenia of children].
OBJECTIVE
To explore the diagnosis and differential diagnosis of refractory cytopenia of children (RCC) according to WHO classification, and discuss the relationship between the cytology reviewed by hematologists and histology reviewed by pathologists.


METHODS
We selected 50 non-severe aplastic anemia cases from 2007 - 2010 in our hospital and collected clinical data. Experienced hematologists and pathologists evaluated bone marrow biopsy and smear respectively.


RESULTS
Of 50 cases, 23 were male and 27 female (M:F = 1:1.17), the median age at diagnosis was 9 years (ranged from 3 to 14 years). 5 patients had disagreement of diagnosis between hematologists and pathologists. In 3 cases hematologists diagnosed as aplastic anemia (AA) and pathologists as RCC, 2 cases vice versa. The final diagnoses of 50 patients reached consensus between hematologists and pathologists were AA 16 cases, RCC 34 cases including 8 refractory cytopenias with multilineage dysplasia (RCMD) cases. All 16 cases AA showed severe hypocellularity. Only 4 cases (25.00%) RCC showed severe hypocellularity, 19 cases (73.08%) RCC showed mild hypocellularity and 3 cases (11.54%) RCC were normal hypocellularity.


CONCLUSIONS
Our results suggests that RCC was not rare in China. The main feature of RCC was dysplasia because of absence of increased blast. RCC was easily confused with AA. The main points of differential were present dysplastic changes of megakaryocyte best appreciated by the hematologists and morphologists and abnormal location of hematopoietic easily observed by pathologists. Overall, cytology and histology were complementary in the investigation of RCC and AA, because of sometimes one might give information that not be given from the other.
Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhan-qi
ZQ
Li
Xiao-fan
XF
Zhu
Wen-yu
WY
Yang
En-bin
EB
Liu
Qi
Q
Sun
Li-huan
LH
Fang
Fu-jun
FJ
Sun
Qing-ying
QY
Yang
Pei-hong
PH
Zhang
D000293:Adolescent; D000741:Anemia, Aplastic / Q000175:diagnosis / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology*; D001856:Bone Marrow Examination; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000473:pathology; D010198:Pancytopenia / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies