Morphological Spectrum of Bone Marrow Changes in Patients of Chronic Kidney Disease: A Cross-sectional Study

Abstract

Introduction: Bone marrow investigations are crucial for Chronic Kidney Disease (CKD) patients with anaemia because they monitor iron stores and reveal morphological abnormalities. In the context of CKD, the examination of bone marrow plays a crucial role in assessing iron levels in individuals with anaemia, as well as providing valuable insights into the specific morphological alterations that occur in CKD patients. Aim: To determine the bone marrow changes and bone marrow iron storage in the patients with CKD; and to study the association between haematological parameters and different CKD stages. Materials and Methods: This cross-sectional study design enrolled 50 CKD patients in the Department of Pathology at MLB Medical College, Jhansi, Uttar Pradesh, India from December 2021 to November 2022. Each patient underwent bone marrow biopsy examination. The Medonic-M Series, an automated haematological analyser, performed the Complete Blood Count (CBC) with red cell indices. Perl’s staining and the Gale Grading Systems were used for assessing iron storage. Descriptive analysis employed frequency and proportions for categorical variables, while mean and Standard Deviation (SD) were used for continuous variables. One-way ANOVA was used to compare differences between variables. Data was collected, compiled, tabulated, entered into a Microsoft Excel sheet, and analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: The study included 50 cases, with the majority of patients being in their fifth and sixth decades of life. Of the total cases, 28 (56%) were males and 22 (44%) were females. Most patients were in Stage-V CKD (N=28, 56%), followed by Stage-III (N=16, 32%), and Stage-IV (N=6, 12%). Among the haematological variables, the difference in Haemoglobin (Hb) was statistically significant (p-value=0.001) in all CKD stages. Iron absorption was found to be normal in 58% (n=29) of patients and increased in 32.00% (n=16) of cases. A total of 26 (52%) out of 50 CKD patients had normocellular bone marrow biopsy and bone marrow smears. Conclusion: Bone marrow examination is undervalued but may be beneficial for CKD patients with anaemia, erythropoietin resistance, thrombocytopenia, or pancytopenia. This method should be considered in centres, whenever possible.