Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology

Abstract

Introduction: Reduced numbers of all three types of peripheral blood cells characterise the hematologic 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, hematological parameters along with bone marrow cellularity and other morphological features on aspiration and trephine biopsy in patients presenting with pancytopenia. Materials and Methods: In the present cross-sectional study for a period of 3.5 years from August 2018 to April 2022, a total 157 patients were included 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 hematological analysis including hemogram 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 and 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. P-value of <0.05 was considered significant. Results: Out of 157 patients, majority (n=120) belonged to adult age group (18-86 years) (76.43%), 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 leukemia, hypersplenism, hypocellular marrow, Hemophagocytic 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 weresignificantly associated with hypo (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 in the present study that megaloblastic anemia was the most common etiology of pancytopenia and the commonest clinical symptoms observed was fever.

Keywords

• bone marrow evaluation
• hemophagocyticlymphohistiocytosis
• megaloblastic anaemia
• pancytopenia