Biological Profile of Dysmyelopoiesis in Bone Marrow Aspirates at the Joseph Ravoahangy Andrianavalona University Hospital, Madagascar

Introduction Dysmyelopoiesis refers to morphological abnormalities affecting bone marrow cells and may arise in both reactive and malignant conditions. Its interpretation can sometimes be challenging, particularly in settings where access to advanced diagnostic tools is limited. The present study aimed to describe the biological characteristics of dysmyelopoiesis observed in bone marrow aspirates. Methods A retrospective descriptive cross-sectional study was conducted at the hematology laboratory of the Joseph Ravoahangy Andrianavalona University Hospital in Antananarivo, Madagascar, over a three-year period from April 2020 to March 2023. Bone marrow smears showing dysplastic features involving at least 10% of cells in one or more hematopoietic lineages were included. Results During the study period, 1006 bone marrow examinations were performed, among which 71 cases of dysmyelopoiesis were identified, corresponding to a frequency of 7.06%. Hematological abnormalities were mainly represented by anemia in 55 cases (77.46%), thrombocytopenia in 51 cases (71.83%), and leukopenia in 33 cases (46.48%). Bone marrow cellularity was predominantly normocellular or hypercellular. Dysplasia involved a single lineage in 24 cases (33.80%), whereas multilineage involvement was observed in 31 cases (43.66%). Megakaryocytic abnormalities were mainly characterized by small-sized megakaryocytes in 19 cases (26.76%) and hypolobulated nuclei in 8 cases (11.27%). In the granulocytic lineage, hypogranulation and nuclear hyposegmentation were identified in 26 cases (36.62%) and 18 cases (25.35%), respectively. Erythroid dysplasia was predominantly marked by nuclear budding in 28 cases (39.44%) and laminated cytoplasm in 27 cases (38.03%). Based on the available clinical and laboratory data, dysmyelopoiesis was considered reactive in 18 cases (22.53%) and suggestive of a malignant process in 53 cases (77.46%). Conclusion The coexistence of reactive and malignant dysmyelopoietic features highlights the diagnostic complexity of dysmyelopoiesis. Accurate interpretation requires integration of clinical and biological findings and a multidisciplinary approach to guide patient management.