Agrawal Rawi, Kumar Satish, Kumar Kaushal, Choudhary Vijayanand
Department of Hematology, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Cureus. 2025 May 11;17(5):e83900. doi: 10.7759/cureus.83900. eCollection 2025 May.
Background This study aimed to characterize bone marrow findings in patients with chronic kidney disease (CKD) in Bihar, India, and to identify correlations between these findings and patients' clinical presentations and hematological parameters. Specifically, this study aimed to (1) document the prevalence and patterns of bone marrow abnormalities in CKD patients, (2) analyze associations between bone marrow findings and CKD stages, and (3) investigate relationships between bone marrow changes and hematological parameters, including anemia severity and morphology. Methodology A retrospective, observational study was conducted by analyzing bone marrow findings of 220 CKD cases admitted at a tertiary care hospital in Bihar, India. Patients' demographic details, clinical features, and laboratory data, including complete blood count, peripheral blood smear, renal function tests, and serum protein electrophoresis, were documented. Standard techniques were utilized to perform bone marrow aspiration and biopsy, which were, subsequently, analyzed by two independent hematopathologists. The data were analyzed for correlations between CKD stages, anemia severity, bone marrow findings, and other clinical parameters. Results The study population was predominantly middle-aged males (63.2%) with a high burden of hypertension (90%) and diabetes (46.4%). All patients presented with anemia, with moderate-grade anemia being the most common (45.9%), and the normocytic, normochromic being the most prevalent subtype (48.6%). Bone marrow examination revealed normal trilineage hematopoiesis in 44.1% of cases. Other notable findings included increased plasma cells (23.2%), erythroid hyperplasia (17.7%), and features of dyspoiesis (8.2%). More advanced stages of CKD were associated with greater plasma cell disorder and dyspoietic feature dominance along with erythroid hyperplasia and lower rates of normal hematopoiesis. Dialysis-dependent patients showed higher rates of bone marrow abnormalities compared to non-dialysis CKD patients. Conclusions This study establishes the reference norms for bone marrow changes in CKD patients in Bihar and demonstrates an elaborate spectrum of hematological changes beyond mere renal anemia. The increased prevalence of plasma cell disorders and dyspoietic changes, especially in advanced CKD, underscores the importance of bone marrow examination in patients with undiagnosed cytopenias and suspected paraproteinemias.
背景 本研究旨在描述印度比哈尔邦慢性肾脏病（CKD）患者的骨髓检查结果，并确定这些结果与患者临床表现及血液学参数之间的相关性。具体而言，本研究旨在：（1）记录CKD患者骨髓异常的患病率及模式；（2）分析骨髓检查结果与CKD分期之间的关联；（3）研究骨髓变化与血液学参数之间的关系，包括贫血严重程度及形态学。
方法 通过分析印度比哈尔邦一家三级护理医院收治的220例CKD病例的骨髓检查结果，进行了一项回顾性观察研究。记录了患者的人口统计学细节、临床特征及实验室数据，包括全血细胞计数、外周血涂片、肾功能检查及血清蛋白电泳。采用标准技术进行骨髓穿刺和活检，随后由两名独立的血液病理学家进行分析。对数据进行分析，以确定CKD分期、贫血严重程度、骨髓检查结果及其他临床参数之间的相关性。
结果 研究人群以中年男性为主（63.2%），高血压（90%）和糖尿病（46.4%）负担较重。所有患者均有贫血，中度贫血最为常见（45.9%），正细胞正色素性贫血是最常见的亚型（48.6%）。骨髓检查显示44.1%的病例三系造血正常。其他显著发现包括浆细胞增多（23.2%）、红系增生（17.7%）及发育异常特征（8.2%）。CKD晚期与更严重的浆细胞紊乱、发育异常特征占优势、红系增生以及正常造血率降低相关。与非透析CKD患者相比，依赖透析的患者骨髓异常率更高。
结论 本研究确立了比哈尔邦CKD患者骨髓变化的参考标准，并展示了除单纯肾性贫血之外广泛的血液学变化谱。浆细胞疾病及发育异常变化患病率增加，尤其是在CKD晚期，凸显了对不明原因血细胞减少和疑似副蛋白血症患者进行骨髓检查的重要性。
