Changes in Megakaryocytes in Cases of Thrombocytopenia: Bone Marrow Aspiration and Biopsy Analysis

Abstract

Background: Thrombocytopenia (platelet counts less than 150,000/μl) is commonly encountered in various hematological disorders including myelodysplastic syndromes as well as various non-myelodysplastic hematological conditions. Aim:The present study was undertaken to calculate the prevalence of various conditions associated with thrombocytopenia and to record the megakaryocytic alterations in various cases of thrombocytopenia. Apart from this by means of statistical analysis it was tried to analyze whether a significant difference existed in megakaryocytic alteration noted in myelodysplastic versus non-myelodysplastic conditions. Materials and Methods:A prospective series of 60 bone marrow aspirations along with concomitant bone marrow biopsies was conducted in a tertiary care centre catering to both urban as well as rural population in north India. Statistical Analysis:The distribution of morphological changes in cases of non myelodysplastic conditions and myelodysplastic were compared using Chi-Square test. A p-value less than 0.05 was considered significant. Results:The commonest cause of thrombocytopenia for which bone marrow examination was sought was dimorphic anaemia (18 cases, 30%), followed by myelodysplastic syndrome (06 cases, 10%) which was followed equally by acute lymphocytic leukemia and blast crisis of chronic myeloid leukemia (CML). Of all the non-MDS conditions apart from dimorphic anaemia, idiopathic thrombocytopenic purpura and chronic myeloid leukemia (blast crisis); megakaryocytic dysplastic forms were not noted in any other condition. In cases of myelodysplasia; dysplastic forms, bare megakaryocytic nuclei, hypogranular forms and micromegakaryocytes were seen. Comparison between frequencies of normal, high and low number of nuclear lobes among MDS (n=9) and non MDS (n=68) conditions were found to be statistically significant. Conclusion:Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning.

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

“…ITP is characterized by thrombocytopenia secondary to peripheral destruction as well as megakaryocyte changes in the bone marrow [2,3]. A shift to young, immature, less polyploid megakaryocytes and fewer mature megakaryocytes is very common.…”

“…A shift to young, immature, less polyploid megakaryocytes and fewer mature megakaryocytes is very common. Dysplastic forms along with bare forms and micro-megakaryocytic forms are seen in half the cases [2]. However the role of bone marrow in ITP has remained doubtful when thorough clinical history and careful general physical examination has been coupled with a detailed peripheral blood smear examination.…”

Bone Marrow Findings in Cases of Thrombocytopenia

“…They were also seen in other studies by Choudhary PK et al (21.2%), Gupta P et al (35.3%), [11,12] Bhasin TS et al (66.6%) and Muhuruy M et al (89%). [14,15] In aplastic anemia,dysplastic megakaryocytes were seen in 33.3% cases in present study as compared to 30.8% by Choudhary PK et al . [11] In megaloblasticanemia, immature megakaryocytes were seen in 3% of cases as compared to 41% in a Section: Pathology study by Muhury M et al, [14] bare in 12.1% as compared to 8% in Gupta P et al, [12] micromegakaryocytes were seen in 24.2% as compared to 25% in Muhury M et al and 50% in Gupta P et al, [12,14] hypogranular in 6% in contrast to 54% in Gupta P et al and hypolobated in 6% in contrast to 54% Gupta P et al [12] The mechanism for such dysmegakaryocytopoesis characterized by abnormal morphology according to Wang C et al, [18] is based on the impaired DNA synthesis and methylation due to folate and vitamin B12 deficiency.…”

“…Male preponderance was seen in present study (61%) which was similar with the results of studies done by Sengupta M et al in which males were 65.9%, [13] Choudhary PK et al in which males were 61.9% and Gupta P et al in which males were 58%. [11,12] Muhury M et al [14] (2009) 75% 24% 89% 12.5% 72% 77.7% -ChoudharyPK et al [11] (2013) 52.3% 50% 21.2% 30.8% ---Bhasin TS et al [15] (2013) 0% 0% 66.6% 0% 44.4% 40% 20% Gupta P et al [12] In the present study most common cause of thrombocytopenia was megaloblastic anemia (33%) which was similar to the study conducted by Choudhary PK et al where megaloblasticanemia was seen in 31.7% of patients. Megaloblasticanemia was the commonest cause in our setup because most of the patients presented had nutritional deficiency.…”

A prospective study on morphological alteration of megakaryocytes amongst megaloblastic anemia cases along with their clinic-haematological manifestations

“…The findings of decrease in megakaryocytes in aplastic anemia and leukemia, and increase in the number of megakaryocytes in immune thrombocytopenia were consistent with other studies. 7,11,12 Morphological changes in megakaryocyte described as, normal megakaryocyte has four to sixteen nuclear lobes and an immature megakaryocyte is defined as a young form of megakaryocyte having scant bluish cytoplasm and lacking lobulation of the nucleus which occupies almost all of the cell. 13 Dysplastic megakaryocytes were defined as those with single/ multiple separate nuclei.…”