Bone marrow aspiration study of megakaryocytic alterations in non myelodysplastic syndrome related thrombocytopenia

Abstract

Background: Thrombocytopenia is a common hematological condition associated with variable etiological factors. Dysplastic changes of megakaryocytes in thrombocytopenia are commonly seen in myelodysplastic syndrome (MDS). However, several studies have described it’s occurrence in non-myelodysplastic hematological conditions. The present study was undertaken to note the various morphological alterations in megakaryocytes (including both dysplastic and non dysplastic changes) in non MDS related thrombocytopenia. Materials and Methods: A prospective study of 78 cases with thrombocytopenia were included in the present study. Cases of MDS were excluded from the study. Informed consent was taken from all the patients with thrombocytopenia and Bone marrow aspiration was done in all cases. Bone marrow aspiration smears were air dried and stained with Leishman stain. Bone marrow aspiration smears were examined for number and various morphological alterations. Special investigations were done in required cases for confirmation of diagnosis. Results: Dysplastic megakaryocytes were observed in 78.6% cases of immune thrombocytopenic purpura and 41.2% cases of megaloblastic anemia. Most common dysplastic feature observed was micromegakaryocyte (32.0%) followed by multiple separate nuclei (21.7%) and hypogranular form was the least observed dysplastic feature (8.9%). Conclusions: Dysplasia in megakaryocytes is a common finding in various non-myelodysplastic syndrome related thrombocytopenia. The mere presence of dysplastic megakaryocyte should not prompt an interpretation of myelodysplastic syndrome and should always be correlated with patient’s clinical and other hematological parameters.