Should we perform bone marrow biopsies in patients with ITP?¶
Answer: Bone marrow biopsy is not required to diagnose ITP — this has been shown in multiple studies. However, this is a nuanced decision in patients over 60 years old and should be made on a case-by-case basis, given the higher prevalence of hematological disorders in this population.
- The ASH 2019 ITP guidelines recommend deferring bone marrow examination: a grade 2C recommendation in adults and grade 1B in children.
- More recent Ontario population-based data (ICES) show an increased risk of hematological malignancy — particularly myeloid — in patients over 60 (PubMed). This has not yet changed recommendations on bone marrow sampling, but has altered our own approach: we follow these patients closely and keep a low threshold to biopsy if any atypical features arise.
- For a concise overview, see this in-a-nutshell review (BJH).
Source: American Society of Hematology 2019 guidelines for immune thrombocytopenia