Diagnostic utility of mast cell analysis in hypoplastic bone marrows for differentiation of aplastic anaemia from hypoplastic myelodysplastic neoplasm: A retrospective study

Abstract

Background: Haematological disorders characterized by hypocellular marrow like aplastic anaemia (AA) and hypocellular myelodysplastic neoplasm (MDS-h) are diagnostic challenges as the clinical and morphological features overlap, while the treatment and prognosis differ. Bone marrow mast cell quantification is proposed as a supplementary diagnostic and prognostic tool to differentiate AA from MDS-h. We aim to study the distribution of mast cells in hypoplastic marrow and determine its role in differential diagnosis of AA and MDS-h. Methods: We analysed bone marrow biopsies of 65 cases of hypoplastic/aplastic marrow received during the year 2015-2021 for the distribution of mast cells using Toluidine Blue special staining. Hematopoietic stem cells were assessed with the help of CD34 immunohistochemistry. Results: Increased mast cells were noted in 55.4% of all the cases, of which 48% were cases of AA and 21% were cases of MDS-h (P: 0.04). Overall, 76% of AA and 33% of MDS-h cases showed increased numbers of mast cells. Reduced hematopoietic stem cells were noted in 69.4% of the cases with elevated mast cells (P: 0.1). Conclusions: Mast cell quantification in trephine biopsy of AA and MDS-h can act as a supplementary diagnostic tool and guide the management of the respective entities. Understanding its role in the bone marrow niche can enhance stem cell transplant treatment.