Changes in Megakaryocytes in Various Hematological Conditions : A Study of Bone Marrow Aspiration in a Tertiary Care Centre

Abstract

INTRODUCTION Dysmegakaryopoiesis is characterized by various Megakaryocytic alterations in bone marrow and includes both dysplastic and non dysplastic features.Dysplastic changes are mostly seen in myelodysplastic syndrome however megakaryocyte alteration have also been noted in some bone marrow aspiration in non myelodysplastic conditions. AIMS OBJECTIVE To evaluate changes in megakaryocytes in various hematological conditions in bone marrow aspiration examination. MATERIAL AND METHODS Study was done at Central Pathology lab in the Department of Pathology GAJRA RAJA MEDICAL COLLEGE GWALIOR over a period of 1.5 year FROM NOV 2019 TO MAY 2021.Total 84 bone marrow were received out of 14 were dilute so excluded from study and results were prepared from 70 cases.Age range was 9 months to 75 years RESULTS AND OBSERVATIONS In this study out of 70 patients, 43 were male and 27 were female.Patients were categorised into neoplastic and non neoplastic category.Out of 70 cases 46 were non neoplastic forming majority while 24 were neoplastic. Out of non neoplastic, megaloblastic anemia was most common while acute leukemia was most frequent in neoplastic category.Bone marrow was evaluated for cellularity. 47 were hypercellular marrow forming majority with 15 cases showing normal cellularity and 08 as hypocellular. Acute leukemia and megaloblastic anemia were two conditions which had hypercellular marrow. The number of the megakaryocytes was considered normal when one megakaryocyte per 3 low power fields was encountered,increased if more than two megakaryocytes per low power field were seen and decreased when one megakaryocyte per five to ten low power fields was documented and absent when no megakaryocytes were seen per ten low power field. Our study showed 27 cases of megakaryocytic hypocellularity, 22 cases normal number of megakaryocytes and 18 as increased number of megakaryocytes. Normally megakaryocytes have four to sixteen nuclear lobes. Immature megakaryocytes were defined as young forms of megakaryocytes with scant bluish cytoplasm and lacking lobulation of the nucleus. Dysplastic megakaryocytes are those with single, multiple/separated nuclei. Micro megakaryocytes were defined as megakaryocytes whose size was that of large lymphocyte or monocyte and which had a single / bi-lobed nucleus. Our study – showed normal megakaryocyte morphology in 32/70 (45%) cases and 35/70 (50%) were with altered morphology. CONCLUSION Dysplastic Morphologic changes in megakaryocyte were not only seen in MDS but also in various non MDS conditions which should be considered during diagnosis.Understanding and detailed knowledge of changes in megakaryocytes,including both cellularity and morphology,can improve the diagnostic accuracy for a wide range of hematological disorders