Morphological Changes of Megakariocytes in Diseases That Cause Thrombocytopenia

Shnain Ali, Mohammad

	Morphological Changes of Megakariocytes in Diseases That Cause Thrombocytopenia
Kerbala Journal of Medicine
Article 5, Volume 3, Issue 7, 2010, Pages 897-901 PDF (0 K)
Author
Mohammad Shnain Ali
Abstract
Background:Morphological changes of megakariocytes are common and they are different according to the cause of thrombocytopenia.Aim: To differentiate the morphological changes of megakariocytes according to the cause of thrombocytopenia.Materials and methods: A total number of 88 cases of symptomatic thrombocytopenia (in which bone marrow examination was indicated) were included. The study was done in a legal private laboratory for hematological investigations (Zaid Bin Ali private laboratory) in karbala city. Patients with thrombocytopenia were referred from different specialists. Blood samples were taken for complete blood picture and platelet count. Thrombocytopenia was defined as platelet number below 100 X109/L. Bone marrow aspirate samples were taken, bone marrow smear slides were made, fixed and stained by Leishman stain, dried and examined under the light microscope for various abnormal morphological changes of megakariocytes. Normal megakariocytes were defined as the largest marrow cells which retain lobulated nuclei (4-16 lobes) while abnormal morphological changes include large magakariocytes with dispersed nuclear lobes, dwarf micromegakario- cytes, juvenile megakariocytes, emperipolesis, megakariocytes with bare nuclei, presence of cytoplasmic vacuoles, hyperpolyploidy (defined as nuclear lobes more than 16) and hypopolyploidy (defined as nuclear lobes less than 4). Using Fisher’s exact test, P value of less than 0.05 was considered to be significant.Results: Large magakariocytes with dispersed nuclear lobes, dwarf micromegakariocytes, juvenile megakariocytes and emperipolesis were 31% (9 out of 29), 34.48% (10 out of 29), 96.55% (28 out of 29) and 72.41% (21 out of 29), respectively in cases of thrombocytopenia which are caused by ITP. Large magakariocytes with dispersed nuclear lobes, dwarf micromegakariocytes, juvenile megakariocytes and emperipolesis were 71.42% (5 out of 7), 85.71% (6 out of 7), 57.14% (4 out of 7) and 57.14% (4 out of 7), respectively in cases of thrombocytopenia which are caused by MDS. In MDS, the presence of large magakariocytes with dispersed nuclear lobes and dwarf micromegakariocytes was statistically significant when compared with other diseases that cause thrombocytopenia (P<0.05).The other abnormal morphological changes of megakariocytes in cases of thrombocytopenia are shown in table 1. While the presence of one or more megakaryocytic changes or absence of such changes in various hematological cases of thrombocytopenia are shown in table 2.Conclusion: There are great interactions and similarities in morphological changes of magakariocytes among different hematological diseases; however, the diagnostic approach will vary when detailed knowledge about morphological changes of megakariocytes is available.Key words: dwarf micromegakariocytes, bone marrow smears, thrombocytopenia, myelodysplastic syndrome.

Statistics Article View: 112 PDF Download: 39