علل اسپلنومگالي و موارد نياز به آسپيراسيون مغز استخوان جهت تشخيص در مركز پزشكي كودكان تبريز

CAUSES OF SPLENOMEGALY AND NEED FOR BONE CAUSES OF SPLENOMEGALY AND NEED FOR BONE

Introduction : Splenomegaly is one of the common and important clinical findings in some of the diseases, careful history, physical examination and ʹnecessary laboratory tests can lead to underlying causes of splenomegaly but in some cases further investigations including marrow aspiration is necessary. This study was done in this respect. Materials & Metheds : During one year from .July 1999 children who were admitted in Tabriz pediatric medical center wiht splenomegaly were studied prospectively. In this study 71 patient had clinical and sonographic splenomegaly wiht or without hepatomegaly. Possible laboratory tests and imaging studies were done for diagnosis of these patients but in cases of failure, marrow aspiration was done. Results : 19 patients were diagnosed by laboratory assessment. In rest of cases marrow aspiration was performed, which led to final diagnosis in 38 patients but it was not helpful in remaining cases. The results indicated that when either high ESR, cytopenia or both were present marrow aspiration was necessary to establish the diagnosis. In this study leukmeia was the most common cause of splenomegaly while visceral leishmaniasis was 2nd in frequently. Discussion : This study shows that indications for bone marrow aspiration in splenomegaly includes decrease in at least two element of blood cells which has sensitivity of 91.8% and speci/icily of 73.3% (p<0.001) and high ESR with bicytopenia has sensitivity of 95.6% and specificity of 44.8% (p<0.001).