Megakaryocytic Alterations in Thrombocytopenia: A Bone Marrow Aspiration Study

Thrombocytopenia is defined as a platelet count of less than 1,50,000 per cubic millimeter. It is a hematological presentation which could have a multitude of causes. This study was conducted with an objective to identify the alterations in number and morphology of megakaryocytes in different hematological disorders causing thrombocytopenia. A prospective bone marrow aspiration study was conducted on 100 patients. Bone marrow aspiration was done, and smears were examined for quantitative as well as qualitative changes. Bone marrow aspirate films were studied by two pathologists separately and megakaryocytic alterations were documented and analyzed using Fischer’s Exact Test. Out of a total of 100 cases of thrombocytopenia, 49% were megaloblastic anaemia, followed by ITP (13%), Dimorphic anaemia (11%), CML-blast crisis (7%) and AML (6%) among others. We observed an increase in the number of megakaryocytes in 28% (n=14) cases of megaloblastic anaemia, and 77% (n=10) cases of ITP. 67.35% (n=33) cases of megaloblastic anemia and 72.73% (n=8) cases of dimorphic anaemia showed hyperlobated megakaryocytes. 61.54% (n=8) cases of ITP showed hypolobated megakaryocytes. Cases of AML, Aplastic anaemia and hairy cell leukaemia showed normal number of nuclear lobes. 51.02 % (n=25) and 61.53 % (n=8) cases of megaloblastic anaemia and ITP respectively showed presence of dysplastic megakaryocytes. Detailed evaluation is key to establish the relationship between megakaryocytic alterations with the different causes of thrombocytopenia.