In the Era of Molecular Pathology, the Role of Morphological Changes in Megakaryocytes in Bone Marrow Aspiration in Cases of Isolated Thrombocytopenia

Background: The most typical cause of thrombocytopenia is immune-mediated thrombocytopenic purpura (ITP). Thrombocytopenia can cause insufficient clot formation and increase the risk of bleeding. Bone marrow aspiration is commonly used for this purpose. ITP was primarily caused by immune-mediated platelet destruction and a megakaryocyte maturation abnormality. The objectives of this study were to evaluate the inter-observer reliability of bone marrow examinations and to identify different megakaryocyte morphological characteristics observed in ITP bone marrow aspiration smears.

Materials and methods: A prospective study was done on 100 cases of bone marrow aspirations of thrombocytopenia in 1 year from 2019 to 2020 in Central India's tertiary care center. Reporting was done by hematopathologists with particular emphasis on megakaryocyte morphology.

Results: A total of 100 cases of bone marrow aspiration were done in one year of thrombocytopenia, out of which 35 (35%) cases were of primary immune thrombocytopenia in which morphological alterations were noted, which constitutes the second most common cause of bone marrow aspiration. In contrast, acute leukemia was the first leading cause. As long as a thorough history and physical examination are conducted, a complete blood count, a peripheral blood smear, and routine coagulation studies reveal no abnormalities other than thrombocytopenia, the literature suggests that performing a routine bone marrow examination to diagnose ITP is unnecessary. Although ITP bone marrow smears showed morphological changes in megakaryocytes, they can be significant as well as insignificant in view of classifying it as myelodysplastic syndrome (MDS).

Conclusion: This study indicates significant abnormalities in the megakaryocytes of ITP patients. Understanding the morphological changes of megakaryocytes in bone marrow aspirates is equally important in the era of molecular diagnostics. It can enhance the accuracy of diagnosis for a variety of hematological disorders and enable the implementation of suitable treatment measures.