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| Year:
2023 |
Month:
April
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Volume:
12 |
Issue:
2 |
Page:
PO45 - PO49 |
Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology
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Correspondence
Alok Kumar, Parineeta Shelke, Preeti Rajeev Doshi, Amit Nisal, Ravindra Nimbargi,
Preeti Rajeev Doshi,
Associate Professor, Department of Pathology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India.
E-mail: prdoshi22@gmail.com :
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Introduction: Reduced numbers of all three types of peripheral blood cells characterise the haematologic condition known as pancytopenia. Practical distinction among various causes of pancytopenia is usually clear but some processes are so closely related that the diagnosis may get complicated and bone marrow examination aids in diagnosis of such cases. It is important to recognise marrow failure syndromes causing pancytopenia. Pancytopenia is a common finding, its explicit discussion is lacking even in major textbooks and has led many authors to highlight the spectrum of causes of pancytopenia.
Aim: To evaluate the various causes of pancytopenia and to evaluate clinical signs and symptoms, haematological parameters along with bone marrow cellularity and other morphological features on aspiration and trephine biopsy in patients presenting with pancytopenia.
Materials and Methods: This cross-sectional study was conducted for a period of 3.5 years from August 2018 to April 2022, on total 157 patients having pancytopenia in a tertiary care centre, Pune, Maharashtra, India. Clinical history was taken for all the cases of pancytopenia. The blood samples were collected for haematological analysis including haemogram and Peripheral Blood Smear (PBS) examination; also Bone Marrow (BM) samples were collected. Aspirates were stained with Leishman and Giemsa. Special stains like Myeloperoxidase (MPO) and Periodic Acid Schiff stain (PAS) were used wherever required. Bone marrow biopsy was fixed in Bouin’s fluid; processed and stained with Haematoxylin and Eosin (H&E) and reticulin stain after decalcification. Results were analysed using Statistical Package for the Social Sciences (SPSS) software (version 26.0) and calculated as frequencies and percentages. A p-value ≤0.05 was considered significant.
Results: Out of 157 patients, majority 120 (76.43%) belonged to adult age group (18-86 years), with the mean age of 40.68±23.34 years. The male to female ratio was 1.34:1. Study showed megaloblastic anaemia encompassing majority of the causes of pancytopenia followed by acute leukaemia, hypersplenism, hypocellular marrow, Haemophagocytic Lymphohistiocytosis (HLH), Myelodysplastic Syndrome (MDS) and aplastic anaemia. Out of 86 (54.78%) of total majority of hypercellular bone marrow patients, 51 (59.3%) had haemoglobin levels of <7 g/dL, while 45 (52.32%) hypercellular bone marrow patients had platelet count of <50000 cells/cumm. Patients with low TLC were significantly associated with hypocellular (p=0.0067) and hypercellular marrow (p=0.0291) compared to normocellular marrow. For reticulocyte count, an increasing trend with low reticulocyte count was seen from normocellular (n=4, 6.9%) to hypocellular (n=12, 20.7%) to hypercellular (n=19, 32.8%) bone marrow, though it was not statistically significant.
Conclusion: It was concluded from the present study that megaloblastic anaemia was the most common aetiology of pancytopenia and the most common clinical symptoms observed was fever.
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