# Bone Marrow Findings in Patients With Renal Disease: Experience of a Single Tertiary Care Center in Bihar

## TL;DR

This study examines bone marrow changes in kidney disease patients in Bihar, finding links between advanced kidney disease and specific blood cell abnormalities.

## Contribution

The study provides region-specific insights into bone marrow abnormalities in CKD patients and their correlation with disease stage and anemia.

## Key findings

- Advanced CKD stages correlate with increased plasma cell disorders and dyspoietic changes in bone marrow.
- Dialysis-dependent patients show higher rates of bone marrow abnormalities compared to non-dialysis patients.
- Normocytic, normochromic anemia is the most prevalent subtype among CKD patients in this population.

## Abstract

Background

This study aimed to characterize bone marrow findings in patients with chronic kidney disease (CKD) in Bihar, India, and to identify correlations between these findings and patients’ clinical presentations and hematological parameters. Specifically, this study aimed to (1) document the prevalence and patterns of bone marrow abnormalities in CKD patients, (2) analyze associations between bone marrow findings and CKD stages, and (3) investigate relationships between bone marrow changes and hematological parameters, including anemia severity and morphology.

Methodology

A retrospective, observational study was conducted by analyzing bone marrow findings of 220 CKD cases admitted at a tertiary care hospital in Bihar, India. Patients’ demographic details, clinical features, and laboratory data, including complete blood count, peripheral blood smear, renal function tests, and serum protein electrophoresis, were documented. Standard techniques were utilized to perform bone marrow aspiration and biopsy, which were, subsequently, analyzed by two independent hematopathologists. The data were analyzed for correlations between CKD stages, anemia severity, bone marrow findings, and other clinical parameters.

Results

The study population was predominantly middle-aged males (63.2%) with a high burden of hypertension (90%) and diabetes (46.4%). All patients presented with anemia, with moderate-grade anemia being the most common (45.9%), and the normocytic, normochromic being the most prevalent subtype (48.6%). Bone marrow examination revealed normal trilineage hematopoiesis in 44.1% of cases. Other notable findings included increased plasma cells (23.2%), erythroid hyperplasia (17.7%), and features of dyspoiesis (8.2%). More advanced stages of CKD were associated with greater plasma cell disorder and dyspoietic feature dominance along with erythroid hyperplasia and lower rates of normal hematopoiesis. Dialysis-dependent patients showed higher rates of bone marrow abnormalities compared to non-dialysis CKD patients.

Conclusions

This study establishes the reference norms for bone marrow changes in CKD patients in Bihar and demonstrates an elaborate spectrum of hematological changes beyond mere renal anemia. The increased prevalence of plasma cell disorders and dyspoietic changes, especially in advanced CKD, underscores the importance of bone marrow examination in patients with undiagnosed cytopenias and suspected paraproteinemias.