Audit Of Hematological Malignancies on Bone Marrow Aspiration: A Retrospective Study of 3 Years at A Tertiary Care Centre

Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1603 International Journal of Medical and Pharmaceutical Research Online ISSN-2958-3683 | Print ISSN-2958-3675 Frequency: Bi-Monthly Available online on: https://ijmpr.in/ Research Article Audit Of Hematological Malignancies on Bone Marrow Aspiration: A Retrospective Study of 3 Years at A Tertiary Care Centre Dr. Gauravi Dhruva1, Dr. Zeal Dhamsaniya2, Dr. Amit Agravat3 1Professor and Head, Department of Pathology, PDU Medical College and Hospital, Rajkot 22nd year Resident, Department of Pathology, PDU Medical College and Hospital, Rajkot 3Professor, Department of Pathology, PDU Medical College and Hospital, Rajkot A B S T R A C T Corresponding Author: Dr. Zeal Dhamsaniya 2nd year Resident, Department of Pathology, PDU Medical College and Hospital, Rajkot Received: 21-09-2025 Accepted: 06-10-2025 Available online: 20-10-2025 Background: Hematological disorders emcompass a wide spectrum of disorders ranging from nutritional anemia to various hematological malignancy. Bone marrow aspiration is a procedure that is often used to evaluate patients with hematological disorders including heamtological malignancies which account for about 6.5% of all cancers worldwide. Aims and Objectives: To study the pattern and type of different hematological malignancies on bone marrow examination. Materials and Methods: This is a retrospective study conducted at P.D.U. Medical college and Hospital, Rajkot over a period of 3 years. It included the patients of haematological malignancies diagnosed on bone marrow examination. Patient’s age, sex, clinical history, laboratory findings and bone marrow diagnosis were noted for every case. Results: Bone marrow aspiration from 58 patients were analyzed. Acute lymphoblastic leukemia was the commonest malignant hematological disorder in the present study. Among the 58 cases, 31 cases were males and 27 were females with the highest number of cases in the age group of 0-20 years. Conclusion: Bone marrow aspiration is a very potent investigation to confirm the diagnosis and management of suspected hematological malignancies. Although an invasive procedure, it is well tolerated by patients and also helps us in reaching a final diagnosis within a short span of time. Copyright © International Journal of Medical and Pharmaceutical Research Keywords: Hematological malignancies, Bone marrow aspiration, Leukemia, Lymphoma. INTRODUCTION Haematologic malignancies are a heterogeneous group of cancers arising from malignant transformation of cells of the bone marrow and or the lymphatic organs. According to the most recent data. Haematologic malignancies are estimated to represent about 6.5 % of all cancers worldwide. They affect all ages and genders world over. The distribution of types may vary with age, sex, culture and the geographic region. Bone marrow aspiration examination is an important tool that aids in the diagnosis and management of various hematological malignancies. The aspirate smears are useful for studying the morphology of cells and for obtaining a differential cell count. Bone marrow aspiration specimens are useful in further diagnostic assays cytochemical and special staining, immune phenotyping cytogenetic analysis and molecular studies. It may be useful in establishing the diagnosis of storage diseases and metastatic non haemopoietic malignancies or when a leuco erythroblastic peripheral blood picture is present. Deviations from the normal may be qualitative with abnormal cell morphology or quantitative with aplasia, hypoplasia or hyperplasia. The aim of this study was to analyse the spectrum of malignant haematological disorders reported on BMA to formulate an effective and rapid method for diagnosing a wide spectrum of diseases. This study will highlight the diagnostic utility of BMA in various haematological disorders, as combined analyses are useful in achieving more accurate and informative data in some diagnostically challenging cases. Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1604 AIMS AND OBJECTIVES To study the pattern and type of different hematological malignancies on bone marrow examination. MATERIALS AND METHODS This was a retrospective observational study aimed to document the prevalence and distribution of different haematologic malignancies at P.D.U. Medical college and Hospital, Rajkot over a 3 year period from January 2022 to January 2025 and included all the patients of haematological malignancies diagnosed on bone marrow examination. Patient’s age, sex, residence, bone marrow indication, clinical history, relevant laboratory and radiological investigations along with bone marrow diagnosis were noted for every case. The bone marrow aspiration was primarily done from posterior superior iliac spine and the trephine biopsy was mostly performed in the same sitting wherever required. The smears were then stained with Leishman stain or May Grunwald geimsa stain and were examined carefully. Special cytochemical stains like Myeloperoxidase (MPO), Sudan black B (SBB) and Periodic acid-schiff (PAS) stain were also utilized for accurate staging and differentiating the type of leukemia. All the data were then statistically analysed and the results were presented as tables and figures. RESULTS Out of total 210 bone marrow aspirations conducted over the duration of 3 years; hematological malignancies accounted for 58 cases of all hematological disorders. Out of those 58 cases; males constituted 31 cases (53.45%) and females constituted 28 cases(46.55%). Male to female ratio was 1.14:1. (Fig 1) Fig 1: Sex wise distribution of hematological malignancies In the present study, the age ranged from 9 months to 80 years. The maximum no. of cases were belonging from 0-20 years (39.65%) of age group followed by 41-60 years (24.14%), 21-40 years (22.41%) ands 61-80 years (13.80%) respectively (Fig 2). 53.45% 46.55% Male Female Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1605 Fig 2: Age wise distribution of hematological malignancies In the present study, the most common presenting symptom was fatigue, which was seen in 85.2% of patients followed by fever in 75% of cases. Other symptoms were loss of appetite (45%), loss of weight (38.5%), bone pain (28.4%), cough and cold (30.3%), petechiae (22%), and CNS symptoms (8 %). While most common presenting signs were splenomegaly and pallor, which were seen in 83% and 80%, respectively, other common signs found were hepatomegaly (62%) and lymphadenopathy (35%). Table 1: Presenting symptoms and signs Symptoms Percentage (%) Fatigue 85.2% Fever 75% Loss of apetite 45% Weight loss 38.5% Bone pain 28.4% Petechiae 22% CNS symptoms 8% Signs Spleenomegaly 83% Hepatomegaly 62% Lymphadenopathy 35% Palor 80% In present study; Anemia was seen in majority of patients and among them 56.90% patients have severe anemia (<7 g%). These findings are correlating with clinical examination, which shows pallor in 82.7% of cases. Most of the patients (58.62%) had white blood cell (WBC) count >10,000/mm3 with 27.60% had >50,000/mm3. Two patients had WBC count <5000/mm3 (Table 2). Table 2: Laboratory finidngs of all patients Laboratory findings Value Number of cases (%) Hemoglobin <7 33 (56.90%) 7-11 24 (41.38%) >11 01 (1.72%) Total 58 (100%) Wbc <5000 02 (3.44%) 5000-9999 06 (10.34%) 10,000-49,999 34 (58.62%) >50,000 16 (27.60%) Total 58 (100%) Platelet count <20,000 07 (12.06%) 20,000-99,999 30 (51.74%) >1,00,000 21 (36.20) Total 58 (100%) 23 13 14 8 0 5 10 15 20 25 0-20 21-40 41-60 61-80 Y-axis: Number of cases X-axis: Age in years Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1606 The various hematological malignancies were majorly divided according to the cell lineages into Lymphoid disorders which constituted 29 cases (50%) and Myeloid disorders that constituted 21 cases (36.2%) and 8 (13.8%) cases were inconclusive (dry tap/ diluted). Fig 3: Distribution of hematological malignancies according to cell lineage The Lymphoid disorders were then classified into Lymphoma which constituted 6.89% (2 cases) , Chronic lymphocytic leukemia 10.34% (3 cases), Plasma cell myeloma(Multiple myeloma) 31.05% (9 cases) and Acute lymphoblastic leukemia 51.72% (15 cases) respectively. Table3: Distribution of Lymphoid neoplasms: (n=29) Lymphoid neoplasms Number of cases (%) Lymphoma: Hodgkings lymphoma Non hodgkins lymphoma 02 (6.89%) Chronic lymphocytic leukemia 03 (10.34%) Plasma cell myeloma(Multiple myeloma) 09 (31.05%) Acute lymphoblastic leukemia 15 (51.72%) Total 29 (100%) The myeloid disorders were divided into Acute myeloid leukemia which constituted 33.33% , Chronic myeloid leukemia (19.04%), myelodysplastic syndrome (33.33%) and myeloproliferative neoplasm (14.30%) Table 4: Distribution of Myeloid neoplasms: (n=21) Myeloid neoplasms Number of cases (%) Acute myeloid leukemia 07 (33.33%) Chronic myeloid leukemia 04 (19.04%) Myelodysplastic syndrome 07 (33.33%) Myeloproliferative neoplasm 03 (14.30%) Total 21 (100%) Out of all hematological malignancies (50 cases); majority cases were leukemic disorders (58%) whereas 42% were non leukemic disorders (Fig 4) and further the distribution of all leukemic disorders is given as below in Fig 5. 010 20 30 40 Lymphoid disoders Myeloid disorders Inconclusive X-axis: Number of cases Y-axis: Hemstological disorders accoring to lineage Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1607 Fig 4: Types of hematological malignancies Fig 5: Distribution of various leukemic disorders In present study, out of all cases of ALL; L1 type of lymphoblast was seen in 80% case, L2 type in 13.33% cases, and L3 type in 6.67% of cases. Hence, L1 is predominant type of lymphoblast in ALL, comprising three-fourth of the cases. In AML, 14.28% of cases had blasts of M1 type, 71.44% had M2 type, and 14.28% had M3 type of myeloblast. Table 5: Blast typing in bone marrow examination: Blast type Number of cases (%) Lymphoblasts (Among total cases of ALL) L1 12 (80%) L2 02 (13.33%) L3 01 (6.67%) Myeloblasts (Among total cases of AML) M1 01 (14.28%) M2 05 (71.44%) M3 01 (14.28%) 58% 42% Leukemic disorders Non Leukemic disorders 0 2 4 6 8 10 12 14 16 ALL CLL AML CML Y-axis: Number of cases X-axis: Leukemic disorders Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1608 Special cytochemical staining was done in cases of Acute leukemias (AML & ALL). Out of all cases of Acute myeloid leukemia; 85.71% cases were positive for MPO stain, 100% positive for SBB stain and PAS stain was positive in 28.57% cases. Out of all cases of ALL, 93.33% cases showed PAS positivity whereas MPO and SBB stains were negative in 100% of cases. (Table 6) Table 6: Cytochemical staining in acute leukemias Cytochemical stains Diagnosis ALL AML MPO stain Positive 0% 85.71% Negative 100% 14.29% SBB stain Positive 0% 100% Negative 100% 0% PAS stain Positive 93.33% 28.57% Negative 6.67% 71.43% ALL: 40x image of bone marrow aspirate showing multiple lymphoblasts and 100x image of bone marrow smear showing large number of lymphoblasts having high N:C ratio, scant cytoplasm and coarse nuclear chromatin (some blasts show hand mirror appreanace) AML: Bone marrow smear showing a significant number of myeloblasts with fine nuclear chromatin and prominent nucleoli and magnified image of myeloblast showing auer rods in cytoplasm Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1609 DISCUSSION Bone marrow aspiration(BMA) is a cytologic preparation of bone marrow cells obtained by aspiration of marrow and a smear of the cells. BMA plays a very important role both in determining the cause of a disease as well as reaching a definitive final diagnosis. It is used to diagnose, confirm, and/or stage hematologic malignancies. The present study was carried out at the Department of Pathology at P.D.U. Medical college and Hospital, Rajkot over a period of 3 years . Total CML: Image showing increased number of immature granulocytes like myelocytes, metamyelocytes and band cells. Multiple myeloma: Bone marrow smear showing multiple plasma cells having large round/oval eccentric nucleus with prominent nucleoli and basophilic cytoplasm Image showing SBB positivity in case of AML. ALL showing PAS postivite lymphoblasts (black arrow) Image showing MPO positivity in AML Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1610 of 58 cases of BMA smears were studied. The observations of the present study were compared and correlated with various other studies. In the present study, the participating patient’s ages ranged from 9m to 80 years, which were in concordance with the findings of N Sangeetha et al (2020), where age ranged from 11m-70 years, Nirali V et al (2020) where cases age ranging from 11m-67 years, and Pudasaini et al (2012) with age group belonging to 9m-75 years. The present study found that the maximum number of cases belonged to the 0-20 years age group. This was in concordance with the findings of Satyasri K et al (2018) where the maximum number of cases belonged to the 0-10 years age group. However, in the study conducted by Renuka Verma et al (2024), Fatima Arshad et al (2021)and N Sangeetha et al (2020) the maximum number of cases belonged to the age group 21-30 years. Table 7 : Comparison of peak age of presentation in various studies. Authors No. of cases Age range years Peak age incidence Pudasaini S et al, Kathmandu (2012) 57 9months-75years 31-45year Satyasri K et al, Vishakhapatnam (2018) 120 1months-85 years 0-10 year M. Atchyuta et al, Chinakakani (2019) 375 13months-83years 31-40 year N Sangeetha et al, Ghanpur (2020) 176 11months-70years 21-30 year NiraliV et al, Baroda (2020) 63 11months-67years 41-50 year Fatima Arshad et al, Karachi (2021) 756 7months-85years 21-30 year Piplani G et al., Manglore (2022) 100 9months-85years 50-59 year Ali Dogan et al., Turkey (2022) 500 18months-87years 35-67 year Gupta C et al. (2023) 323 5months-85years 11-20 year Sanjana et al (2024) 48 4months-80years 60-80year RenukaVerma et al., Rohtak (2024) 518 3months-86years 21-30 year Our study, Rajkot (2025) 58 9months80 years 0-20 year In the present study, a total of 58 cases were included out of which 31 were male and 27 were female. Male preponderance was observed in the present study and the male: female ratio was 1.14:1 which was in concordance with the study conducted by Renuka Verma et al (2024), Gupta C et al (2023), Pudasaini S et al (2012) and Satyasri K et al (2018) were male: female ratio was1.3:1, 1.6:1, 1.1:1and 1.4:1 consecutively. However, in studies conducted by Fatima Arshad et al (2021) female preponderance was observed, and the male: female ratio was 1:1.25 which was discordant with the present study. (Table No. 8) Table 8: Sex-wise distribution of study population in various studies Authors No. of cases Male:Female ratio Pudasaini S et al, Kathmandu (2012) 57 1.1:1 Satyasri K et al, Vishakhapatnam (2018) 120 1.1:1 M. Atchyuta et al, Chinakakani (2019) 375 1.4:1 N Sangeetha et al, Ghanpur (2020) 176 1.1:1 NiraliV et al, Baroda (2020) 63 1:1.25 Fatima Arshad et al, Karachi (2021) 756 1.8:1 Piplani G et al., Manglore (2022) 100 1.7:1 Ali Dogan et al., Turkey (2022) 500 1.2:1 Gupta C et al. (2023) 323 1.06:1 Sanjana et al (2024) 48 1.08:1 RenukaVerma et al., Rohtak (2024) 518 1.3:1 Our study, Rajkot (2025) 58 1.14:1 In the present study; the most common malignancy was Acute lymphoblastic leukemia which was similar to Satyasri K et al and Renuka Verma et al. However, M. Atchyuta et al and Fatima Arshad et al showed the most common malignant haematological disorder was Chronic leukemia which was discordant with current study. (Table 9) Dr. Gauravi Dhruva, et al. Audit Of Hematological Malignancies On Bone Marrow Aspiration: A Retrospective Study Of 3 Years At A Tertiary Care Centre. Int. J Med. Pharm. Res., 6 (5): 1603‐1611, 2025 1611 Table 9: Comparison of the spectrum of BMA among various studies Authors Hematological malignancies Pudasaini S et al, Kathmandu (2012) Acute leukemia Satyasri K et al, Vishakhapatnam (2018) Acute lymphoblastic leukemia M. Atchyuta et al, Chinakakani (2019) Chronic myeloid leukemia N Sangeetha et al, Ghanpur (2020) Acute myeloid leukemia NiraliV et al, Baroda (2020) Acute leukemia Fatima Arshad et al, Karachi (2021) Chronic leukemias Piplani G et al., Manglore (2022) Myeloproliferative neoplasm Ali Dogan et al., Turkey (2022) Acute leukemia Gupta C et al. (2023) Acute leukemia Sanjana et al (2024) Acute myeloid leukemia RenukaVerma et al., Rohtak (2024) Acute lymphoblastic leukemia Our study, Rajkot (2025) Acute lymphoblastic leukemia CONCLUSION The Bone marrow aspiration study remains an important diagnostic tool for many hematological disorders. A complete clinical examination, patient history, and investigations like peripheral blood examination along with bone marrow examination complete the diagnostic workup for many hematological conditions. In present study, leukaemias were the most prevalent haematologic malignancies and ALL was the predominant leukaemia as well as the most prevalent haematological malignancy in our centre. REFERENCES 1. Renuka V, Rajnish K, Veena G, Sumiti G, Monika G, Sunita S. Bone Marrow Examina tion in Various Haematological and Non Hae matological Disorders. Journal of Clinical and Diagnostic Research. 2024 Apr, Vol-18(4): EC 07-EC12. 2. Sanjana N, Prasanthi C, Vasundara G. Spec trum of Hematological Disorders In Bone Mar row Examination. Asian J Pharm Clin Res, Vol 17, Issue 1, 2024, 49-52 3. Gupta C, Kaur A, Bhardwaj S. Spectrum of He matological Disorders on Bone Marrow Aspiration - An Experience in a Tertiary Care Center. JK Science 2023;25(4):210-3 4. Dogan A, Demircioglu S. Diagnostic im portance of bone marrow aspiration evaluation: A single-center study. Pak J Med Sci. 2022; 38 (4):811-815. 5. Piplani and Teerthanath. Study of Spectrum of Lesions in Bone Marrow Aspiration and Tre phine Biopsy from a Tertiary Care Centre in South India. Int J Pathol Clin Res 2022, Volume 8 | Issue 2 8:138 6. Fatima A, Mehwish S, Anum M & S. Spectrum of hematological disorders in bone marrow as pirate and biopsy at tertiary care hospital, Kara chi. International Journal of Endorsing Health Science Research Volume 9 Issue 2 [2021] 7. Dr. Nirali. V. Shah, Dr. Falguni Goswami, Dr. Pratik Rathod, Dr. Jeetendra Nasit, Dr. Manisha Singh, Dr. Roopam Gidwani. Diagnostic spec trum of Bone Marrow Aspiration in Evaluation of Haematological and Nonhematological dis orders. International Journal of Medical Science and Dental Research Volume 03, Issue 04 Sep tember-October 2020, PP 21-29 8. MNK Dhanalakshmi, N Sangeetha, J Sheeja. Study of Bone Marrow Aspiration for a Period of Two Years.Indian J Pathol Res Pract 2020;9 (2 Part I):9–15. 9. M. Atchyuta, P. Premalatha, I. V Renuka, P. A. V Krishnamashary, V. Tejeswini. Spectrum of hematological diseases diagnosed by bone mar row examinationIndian Journal of Pathology and Oncology, April-June, 2019;6(2):185-189 10. Satyasri K, Kartheek BVS, Sinha S. The spec trum of bone marrow morphological findings and its diagnostic role in evaluation of haema tological disordersa retrospective study. J.