A prospective study on morphological alteration of megakaryocytes amongst megaloblastic anemia cases along with their clinic-haematological manifestations

Authors

  • Benazeer Mansuri Department of Pathology, GMERS Medical College Vadnagar, Mehsana, Gujrat, India
  • Komal P. Thekdi Department of Community Medicine, GMERS Medical College Vadnagar, Mehsana, Gujrat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20173996

Keywords:

Hypo productive, Hyper destructive thrombocytopenia, Megaloblastic anemia

Abstract

Background: Megaloblastic anemias are hematologic disorders in which abnormal DNA synthesis causes blood and bone marrow disorders. The cause of thrombocytopenia in megaloblastic anemia has been postulated as hypoproduction in some studies, whereas ineffective thrombopoeisis has been proposed in other. Objective was to study spectrum of clinic-hematological features in megaloblastic anemia and comparative bone marrow aspiration study of thrombocytopenia secondary to megaloblastic anemia, hypoproduction and hyper-destruction. This study was done to understand the various megakaryocytic alterations in hematological disorders presenting with thrombocytopenia due to different mechanisms.

Methods: Total 85 cases of thrombocytopenia included in the study. Bone marrow finding in 33 cases of thrombocytopenia of megaloblastic etiology were compared with 34 cases of marrow proven hypo productive thrombocytopenia (aplastic anemia, acute leukemia) and 19 cases of hyper destructive thrombocytopenia (immune thrombocytopenia).

Results: Most common age group presenting megaloblastic anemia is 11-20 year, with male to female ratio is1.2:1, most common complaint were generalized weakness and fever. In megaloblastic anemia 24.33%, 60% and 15.67% of the cases shows increase, decrease and normal megakaryocytes respectively. Dysplastic megakaryocytes were observed in 24.3%, 27% and 20.5% of the cases of megaloblastic anemia, acute leukaemia and immune thrombocytopenic purpura respectively.

Conclusions: Both hypoproduction and ineffective thrombopoiesis are the underlying path mechanisms in megaloblastic thrombocytopenia as evidenced by the marrow findings. We hereby infer that megaloblastic thrombocytopenia is to be included as a separate category apart from hypo proliferative and hyper destructive groups. The presence of dysplastic megakaryocyte should not prompt an interpretation

References

Gomber S. Brief report on clinico-hematological profile of megaloblastic anemia. Indian Pediatrics. 1998:35(1):55-8.

Handin RI. Hematology and Oncology. 4th Edition, 1995:72-79.

Kunningham FG, Hauth JC, Leveno KJ, Gilstrap L. Williams Obstetrics. Hematologic Disorders, 20th Edition, Chapter 5; 2005:1325-1326.

Sifakis S, Pharmakides G. Anemia in pregnancy. Ann New York Academy Sci. 2000;900:125-36.

Trueman ET, Sherman L, Boyd JA. Megaloblastic anaemia of pregnancy with severe thrombocytopenic purpura- case report and review of the literature. Canadian Med Assoc J. 1959;81:243-7.

Katti TV, Mhetre SC, Annigeri C. How far are the platelet indices mirror image of mechanism of thrombocytopenia-mystery still remains? Int J Adv Med. 2014;1(3):200-5.

Choudhary PK, Sing SK, Basnet RB. Study of megakaryocytes in bone marrow aspiration smears in patients with thrombocytopenia. J Patho Nepal. 2013;3:476-81.

Sarode R, Garewal G, Marwaha N, Marwaha RK, Varma S, Ghosh K, et al. Pancytopenia in nutritional megaloblastic anaemia, a study from North-West India. Trop Geogr Med. 1989;41:331-6.

Baker SJ, Ignatius M, Johnson S. Hyperpigmentation of skin: a sign of vitamin B12 deficiency. Br Med J. 1963;2:1713-5.

Chanarin I, O'Hea AM, Malkowska V, Rinsler MG, Price AB. Megaloblastic anaemia in a vegetarian Hindu community. Lancet. 1985;326(8465):1168-72.

Muhury M, Mathai AM, Rai S, Naik R, Pai MR, Sinha R. Megakaryocytic alterations in thrombocytopenia: a bone marrow aspiration study. Ind J Pathol Microbiol. 2009;52(4):490-4.

Bhasin TS, Sharma S, Manjari M, Mannan R, Kansal V, Chandey M, et al. Changes in megakaryocytes in cases of thrombocytopenia: bone marrow aspiration and biopsy analysis. JCDR. 2013;7(3):473-9.

Gupta P, Goswami A, Chavda J, Goswami N, Shah S. Study of megakaryocytes in bone marrow aspiration smears in patients with thrombocytopenia. J Dental Med Sci. 2015;14(6):30-3.

Mckenzie SB, editor. Willaims and Wilkins; Textbook of hematology. 2nd ed. Pennsylvania. 1996.

Rajashekar RB, Mahadevappa A, Patel S. Evaluation of thrombocytopenia in megaloblastic anemia by platelet indices and megakaryocytes- comparison with hypoproduction and hyper destruction. National J Laboratory Med. 2017;6(1): PO18-22.

Houwerijl EJ, Blom NR, Van der Want JJ, Esselink MT, Koornstra JJ, Smit JW, et al. Ultrastructural study shows morphologic features of apoptosis and para-apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura. Blood. 2004;103:500-6.

Shadduck. Aplastic anemia: review of 27 cases. Lancet. 2001;1:657-67.

Lim SH, Ifhtikharuddin JJ. Autoimmune thrombocytopenic purpura complicating lymphoproliferative disorders. Leuk Lymphoma. 1994;15:61-4.

Downloads

Published

2017-08-26

How to Cite

Mansuri, B., & Thekdi, K. P. (2017). A prospective study on morphological alteration of megakaryocytes amongst megaloblastic anemia cases along with their clinic-haematological manifestations. International Journal of Research in Medical Sciences, 5(9), 4127–4132. https://doi.org/10.18203/2320-6012.ijrms20173996

Issue

Section

Original Research Articles