Verma Deepshikha, Singh Lal Pranay, Mandloi Preeti, Ahirwar Rajnikant
Department of Pathology, Atal Bihari Vajpayee Government Medical College, Vidisha, IND.
Cureus. 2024 Nov 24;16(11):e74336. doi: 10.7759/cureus.74336. eCollection 2024 Nov.
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.
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.
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).
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.
血小板减少症最典型的病因是免疫性血小板减少性紫癜（ITP）。血小板减少会导致凝血形成不足，并增加出血风险。骨髓穿刺常用于此目的。ITP主要由免疫介导的血小板破坏和巨核细胞成熟异常引起。本研究的目的是评估骨髓检查的观察者间可靠性，并识别在ITP骨髓穿刺涂片中观察到的不同巨核细胞形态特征。
对2019年至2020年期间印度中部三级医疗中心1年内100例血小板减少症患者的骨髓穿刺进行了前瞻性研究。由血液病理学家进行报告，特别强调巨核细胞形态。
在血小板减少症的1年中，共进行了100例骨髓穿刺，其中35例（35%）为原发性免疫性血小板减少症，观察到形态学改变，这是骨髓穿刺的第二大常见原因。相比之下，急性白血病是首要原因。只要进行了全面的病史和体格检查，全血细胞计数、外周血涂片和常规凝血研究除血小板减少外未发现其他异常，文献表明进行常规骨髓检查以诊断ITP是不必要的。虽然ITP骨髓涂片显示巨核细胞有形态学变化，但就将其分类为骨髓增生异常综合征（MDS）而言，这些变化可能显著也可能不显著。
本研究表明ITP患者的巨核细胞有明显异常。在分子诊断时代，了解骨髓穿刺物中巨核细胞的形态变化同样重要。它可以提高对各种血液系统疾病的诊断准确性，并有助于实施合适的治疗措施。
