# Hematological Disease Profile in the Tribal Population of Northern Maharashtra Based on Bone Marrow Examination: A Retrospective Study

## TL;DR

This study examines bone marrow findings in a tribal population in northern Maharashtra to better understand hematological diseases and the diagnostic value of bone marrow exams.

## Contribution

The study provides new insights into hematological disorders in India's tribal population using bone marrow examination data.

## Key findings

- Bone marrow exams showed higher diagnostic accuracy than peripheral blood smears for anemia and myelodysplastic syndromes.
- Myelodysplastic syndrome was detected exclusively through bone marrow exams.
- Anemia was the most common clinical indication for bone marrow examination in the studied population.

## Abstract

Background

Bone marrow examination (BME), comprising bone marrow aspiration (BMA) and bone marrow biopsy (BMB), remains vital for diagnosing hematological disorders, especially when peripheral blood findings are inconclusive. Data on marrow pathology among India’s tribal population are limited. Hence, this study aimed to assess clinical indications, diagnostic utility, and association between peripheral blood smear (PBS) and bone marrow findings in the tribal population of northern Maharashtra.

Methodology

This retrospective, descriptive study included 60 tribal patients who underwent BMA and BMB between January 2023 and March 2024. After excluding inadequate and normal samples, 39 cases were analyzed. Demographic, clinical, and morphological data were reviewed. Association between PBS and bone marrow findings was tested using the Z-test for proportions (p < 0.05).

Results

Among 60 tribal patients who underwent BME, 39 (65%) yielded adequate and interpretable findings for analysis. Anemia was the most common indication, observed in 23 (59.0%) patients, including microcytic 11 (28.2%), megaloblastic 9 (23.1%), and dimorphic 3 (7.7%) cases. Bone marrow showed a significantly higher diagnostic yield in microcytic anemia compared with PBS (79.0% vs. 21.0%; p < 0.01). Myelodysplastic syndrome (5, 12.8%) was detected exclusively on marrow (p = 0.002). Myeloproliferative neoplasms (5, 12.8%), plasma cell dyscrasias (4, 10.3%), and immune thrombocytopenic purpura (2, 5.1%) were also identified.

Conclusions

BME demonstrated superior diagnostic accuracy over peripheral smear, particularly for anemia and myelodysplastic syndromes. Strengthening hematopathology services in tribal regions can facilitate earlier diagnosis and management of reversible hematologic disorders, improving outcomes in underserved populations.