THE ROLE OF BONE MARROW ANALYSIS IN ETIOLOGICAL CLASSIFICATION OF PANCYTOPENIA: A CLINICOPATHOLOGICAL PERSPECTIVE FROM MULTICENTER CROSS SECTIONAL STUDY

Abstract

Background: Pancytopenia is a critical hematological condition with diverse etiologies, ranging from nutritional deficiencies to malignant marrow disorders. Accurate etiological classification is essential for appropriate therapeutic interventions and prognostic evaluation. Bone marrow examination remains the gold standard for establishing the underlying cause; however, large-scale multicenter evidence is limited in low- and middle-income countries.

Objective: To evaluate the role of bone marrow analysis in the etiological classification of pancytopenia and to establish clinicopathological correlations in a multicenter cross-sectional cohort. Methodology: A multicenter cross-sectional study was conducted across three public sector tertiary care hospitals of Lahore between March 2024 and December 2024. A total of 420 patients aged 12–75 years presenting with pancytopenia were enrolled. Clinical history, hematological parameters, and relevant biochemical investigations were recorded. Bone marrow aspiration and trephine biopsy were performed in all cases, with findings categorized into nutritional, marrow failure, infiltrative, infectious, and malignant etiologies. Statistical analysis was performed using chi-square and logistic regression models to identify associations between clinical features and marrow findings.

Results & Findings: Out of 420 patients, bone marrow evaluation provided a definitive diagnosis in 398 (94.8%) cases. The most frequent cause was megaloblastic anemia (38.1%), followed by aplastic anemia (21.4%), acute leukemias (17.9%), myelodysplastic syndromes (7.6%), hypersplenism-related secondary marrow changes (6.9%), and infections including tuberculosis and leishmaniasis (3.1%). Age-stratified analysis showed nutritional deficiencies predominantly in patients <30 years (p < 0.001), while aplastic anemia and hematological malignancies were significantly higher in patients >40 years (p = 0.002). Male predominance was observed in aplastic anemia (M:F = 2:1), whereas acute leukemias showed no gender bias. Clinicopathological correlation enhanced diagnostic precision in 22% of cases with overlapping morphological features.

Conclusion: Bone marrow analysis is a pivotal diagnostic modality in the etiological stratification of pancytopenia, enabling distinction between reversible nutritional causes and malignant or marrow failure syndromes. This multicenter evidence highlights the predominance of megaloblastic anemia in younger populations and hematological malignancies in older cohorts, reinforcing the indispensable role of marrow examination in guiding management strategies. Strengthening diagnostic hematopathology infrastructure is imperative for timely and accurate evaluation of pancytopenia in resource-constrained healthcare systems.