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Bone Marrow Score of Wang et al for Identifying an Immunocompetent Patient with Fever of Unknown Origin (FUO) Who Should Have Bone Marrow Biopsy

Description

Wang et al reported a score for identifying an immunocompetent patient with fever of unknown origin (FUO) who should have a bone marrow biopsy. This can help to identify patients with a hematological disorder. The authors are from Taipei Veterans General Hospital and National Yang-Ming University.


Patient selection: immunocompetent patient with FUO

 

Outcome: early bone marrow biopsy

 

Parameters:

(1) absolute neutrophil count per µL

(2) hemoglobin in g/dL

(3) serum LDH

(4) platelet count per µL

(5) splenomegaly

(6) serum ferritin in ng/mL

(7) leukoerythroblastic changes in peripheral blood smear

 

Parameter

Finding

Points

absolute neutrophil count

>= 2,000 per µL

0

 

< 2,000 pe µL

1

hemoglobin

>= 10 g/dL

0

 

< 10 g/dL

1.5

serum LDH

<= ULN

0

 

> ULN

1.5

platelet count

>= 100,000 per µL

0

 

< 100,000 per µL

2

splenomegaly

absent

0

 

present

4

serum ferritin

<= 1,000 ng/mL

0

 

> 1,000 ng/mL

5.5

leukoerythroblastic changes

absent

0

 

present

6

 

total score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 21.5

• A score < 6 was not associated with a hematologic disorder.

• A score >= 6 was 77% specific for a hematologic disorder.

 

Performance:

• The area under the ROC curve was 0.89.


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