Diagnostic Relevance of Quantitative and Qualitative Megakaryocytic Morphological Variations in Hematological Alterations

AIMS: The differentiation of various causes of thrombocytopenia remains a diagnostic challenge, often requiring detailed bone marrow examination. This study aimed to analyze megakaryocyte (MK) morphology and identify statistically significant features that distinguish immune thrombocytopenia (ITP) from myeloid malignancies such as chronic myelogenous leukemia (CML) and myelodysplastic syndromes (MDS), while evaluating their clinical associations. MATERIALS AND METHODS: A retrospective, cross-sectional study was conducted on 73 patients at a tertiary care center in Ranchi, Jharkhand. Bone marrow aspirates were analyzed to evaluate MK concentration, size, nuclear lobation, cytoplasmic granularity, and clustering patterns. Morphological findings were correlated with clinical presentations and platelet counts. RESULTS: In a study, the most prevalent diagnoses, with ITP patients being significantly younger (13.5 ± 4.93 years) and presenting with the most severe cytopenia (P < 0.001). Clinical presentations correlated significantly with final diagnoses, with bleeding manifestations predominating in ITP. Megakaryocytic quantity and cytoplasm/granulation varied sharply by pathology, showing increased megakaryopoiesis and abundant cytoplasm in ITP, contrasted by decreased megakaryopoiesis and scant cytoplasm in CML. CONCLUSIONS: Morphological variations in bone marrow MKs specifically size, nuclear lobation, cytoplasm granulation, and clustering patterns show distinct, pathology-specific clustering that correlates strongly with clinical diagnoses such as ITP, CML, and MDS.