Role of Routine Bone Marrow Biopsy Preoperatively in Non Cirrhotic Portal Hypertension

Background: A bone marrow biopsy is routinely done prior to surgical intervention in patients with Extrahepatic portal venous obstruction (EHPVO) and Non-Cirrhotic portal fibrosis (NCPF) to rule out other aetiologies pertaining to pancytopenia. However, there are no guidelines for whether it is indicated or has any value in management protocols.

Methods: 58 patients were retrospectively analyzed who had undergone surgery for established cases of EHPVO or NCPF. The diagnosis was made with imaging studies, either a doppler ultrasound or a CT scan. Baseline characteristics were analyzed, and the patients who had undergone a bone marrow biopsy preoperatively were compared to those who hadn't. The impact of the bone marrow study on the line of management was also evaluated.

Results: There was no difference in the outcomes of patients who have undergone bone marrow biopsy and those who didn’t in univariate analysis. Also, we have noted that none of the patients had any deviation in the line of treatment.

Conclusions: To our knowledge, this is the first study to evaluate the role of preoperative bone marrow biopsy in non-cirrhotic portal hypertension. A bone marrow biopsy is an invasive procedure, time-consuming, and has its complications. Cytopenia in non-cirrhotic portal hypertension can be attributed to hypersplenism and portal hypertension, and a routine bone marrow biopsy may be avoided.