Spectrum and Frequency of Megakaryocyte Morphological Alterations in Thrombocytopenia: A Cross-Sectional Study from a Tertiary Care Centre in Eastern India

Abstract

Background: Thrombocytopenia is a commonly encountered hematological abnormality associated with diverse etiologies ranging from transient infections to primary bone marrow disorders. Bone marrow examination remains an important diagnostic tool in evaluating thrombocytopenia, particularly through assessment of megakaryocyte morphology. Alterations in megakaryocyte number, maturation, and nuclear characteristics often provide important clues regarding the underlying pathology.
Objective: To evaluate the spectrum and frequency of megakaryocyte morphological alterations in patients presenting with thrombocytopenia.
Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Pathology at Rajendra Institute of Medical Sciences (RIMS), Ranchi, over a period of 1.5 years. A total of 73 patients with thrombocytopenia undergoing bone marrow examination were included. Bone marrow aspiration smears were stained with Leishman stain and examined for megakaryocyte morphology. Morphological alterations including hypolobation, micromegakaryocytes, bare nuclei, immature forms, emperipolesis, cytoplasmic vacuolization, and dysplastic changes were evaluated. Statistical analysis was performed using SPSS version 25.0. Chi-square test and Student’s t-test were used where appropriate, and p-value <0.05 was considered statistically significant.
Results: The mean age of study participants was 41.8 ± 15.6 years, with a male predominance (58.9%). Immune thrombocytopenic purpura (ITP) was the most common cause of thrombocytopenia (32.9%), followed by megaloblastic anemia (20.5%) and aplastic anemia (13.7%). Increased megakaryocytes were observed in 57.5% of cases, while decreased megakaryocytes were noted in 24.7%. Hypolobated megakaryocytes were the most frequent morphological abnormality (50.7%), followed by bare megakaryocytic nuclei (45.2%), immature megakaryocytes (39.7%), micromegakaryocytes (28.8%), and emperipolesis (19.2%). Dysplastic changes were significantly more common in myelodysplastic syndrome and leukemia cases (p = 0.002).
Conclusion: Megakaryocyte morphological evaluation provides valuable diagnostic information in thrombocytopenia. Specific alterations such as hypolobation, micromegakaryocytes, and dysplastic forms may help differentiate reactive from neoplastic and marrow failure conditions.