Vol. 3, Issue 5, Part C (2017)

Thrombocytopenia is defined as a platelet count less than 150 x 10⁹/liter (Lichtman AM, Beutler E et al. 2006). A low platelet count could result from peripheral destruction by an immune or non-immune mechanism; decreased production resulting from an inherited or acquired marrow disease; or splenic pooling. Pseudothrombocytopenia can occur in asymptomatic patients, and results from in vitro clumping of platelets following blood collection (Lichtman AM, Beutler E et al. 2006). The present study was undertaken in the department of pathology, Silchar Medical College to study the etiopathogenesis, and any bone marrow changes associated with thrombocytopenia. Total 80 patients with decreased platelet count were selected from among the patients attending the outpatient department and the patient admitted, along with concomitant bone marrow aspiration was conducted to Silchar Medical College Silchar during the period of one year, which included subjects of both sexes of different age groups. In this study, thrombocytopenia was found to be associated with megaloblastic anemia (38 cases, 47.5%), hematological malignancies (26 cases, 32.5%), infections (10 cases,12.5%), ITP (Immune- thrombocytopenic purpura) (4 cases,5%) followed by aplastic anemia (2 cases,2.5%). In the present study, a total of 80 bone marrow aspirates was performed. Megaloblastic anemia (38 cases,47.5%) with bone marrow morphology showed mostly hyperlobated megakaryocytes (34 cases out of 38 cases) followed by 2 cases with dysmegakaryopoietic feature and the remaining 2 cases showed normal megakaryocytic morphology. Second most common cause, total of 21 cases of acute leukemia (15 cases of Acute Myeloid Leukaemia & 6 cases of Acute Lymphoblastic Leukaemia) were found. Megakaryocyte morphological alteration most commonly found in the acute leukemia cases were mainly immature forms and dysplastic forms. Dysplastic forms of megakaryocytes were found in both in Myelodysplastic Synddrome and non-MDS conditions like megaloblastic anemia, Acute Myeloid Leukaemia, Chronic Myeloid Leukaemia in blast crisis. But finding of micromegakaryocytes in bone marrow were observed only in MDS. Morphological alterations of megakaryocytes in case of infection associated thrombocytopenia were mainly immature forms and presence of cytoplasmic vacuolation. Cases of ITP had an increase in megakaryocytic number and morphologically showed predominantly immature and hypogranular forms. It has been seen that from above study, megaloblastic anemia is the most common cause of thrombocytopenia followed by haematological malignancies of which acute myeloid leukemia is the leading cause. Proper clinical examination along with haematological investigations including bone marrow morphological assessment leads to a clue in establishing the final diagnosis.