Morphological Spectrum of Megakaryocytic Alterations in Bone Marrow Aspiration and Biopsy of Patients with Thrombocytopenia – A Tertiary Care Hospital Based Study

Rushali Patel; Keyuri Patel; Zalak Parmar

doi:10.21276/apalm.3799

Authors

Rushali Patel Department of Pathology, Pramukhswami Medical College & Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
Keyuri Patel Department of Pathology, Pramukhswami Medical College & Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
Zalak Parmar Department of Pathology, Pramukhswami Medical College & Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India

DOI:

https://doi.org/10.21276/apalm.3799

Keywords:

bone marrow aspiration and biopsy, megakaryocytes, thrombocytopenia

Abstract

Background: Megakaryocyte morphology is vital for platelet production, and abnormalities at any developmental stage can lead to thrombocytopenia(<150,000/µL). Bone marrow evaluation helps distinguish decreased platelet production from increased peripheral destruction. This prospective study assessed dysplastic and non-dysplastic megakaryocytic changes in thrombocytopenia, bicytopenia, and pancytopenia, including non-MDS disorders. Aim and objectives: To study megakaryocytic alterations in a patient with thrombocytopenia, bicytopenia, and pancytopenia in BMA and BMB. The study goal was to provide a comprehensive morphological assessment and support clinical correlation in haematological disorders.

Materials and methods: The study at Pramukhswami medical college, included 55 thrombocytopenia cases. Bone marrow aspiration and biopsy were reviewed independently by two hematopathologists. Inter-observer discrepancies were resolved by consensus review to standardize findings. Megakaryocyte counts were assessed per 10 LPF, with morphology evaluated in at least 30 cells. Dysplasia was strictly defined as abnormalities in ≥10% of megakaryocytes.

Results: ITP(18.2%), AOCD(12.7%), and AML(10.9%) were the leading causes of thrombocytopenia. Megakaryocyte counts were increased in ITP and AOCD due to compensatory marrow response, and reduced in aplastic anaemia and AML because of marrow suppression. Dysplastic megakaryocytic features were commonly seen in ITP, AOCD, and AML, along with frequent non-dysplastic changes such as hypolobation, immaturity, emperipolesis, and bare nuclei. Bone marrow aspiration offered better cytological detail, while biopsy was superior for evaluating marrow architecture.

Conclusion: Bone marrow aspiration and biopsy are essential for assessing megakaryocyte number and morphology in thrombocytopenia, bicytopenia, and pancytopenia. Identifying dysplastic features in non-MDS conditions like ITP, IAT and AOCD highlights the need for careful clinical correlation to avoid misdiagnosis.

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