Application of bone marrow cytology combined with coagulation test to identify the etiology of thrombocytopenia

CHENG Qiaoqiao; WANG Bo; XU Yuanhong

doi:10.3969/j.issn.1002-7386.2025.09.012

Abstract：Objective To investigate the value of bone marrow cytology combined with coagulation test in identifying the etiology of thrombocytopenia.Methods A total of 92 patients with thrombocytopenia admitted from September 2021 to June 2023 were selected as observation objects,including 38 patients in the immune thrombocytopenia(ITP)group,8 patients in the myelodysplastic syndrome(MDS)group,5 patients in the systemic lupus erythematosus(SLE)group and 6 patients in the aplastic anemia(AA)group.There were 35 cases of hematological malignancy(HM),including 25 cases of leukemia,6 cases of multiple myeloma,and 4 cases of lymphoma.Bone marrow cytology,blood clotting indexes(partial activated thrombin time[APTT],platelet count[PLT],prothrombin time[PT],international standardized ratio[INR],thrombin time[TT],D-dimer[D-D],and fibrinogen[FIB])were examined in all patients.The bone marrow cytology and coagulation index of patients with different etiologies of thrombocytopenia were compared.The detection rate of different protocols and the value of bone marrow cytology combined with coagulation test in the differential diagnosis of the etiology of thrombocytopenia were analyzed.Results Changes at varying degrees in the bone marrow images were detected in all the ITP group,AA group,MDS group,SLE group and HM group.Patients in the ITP group and AA group had the lowest PLT,and those in the HM group had the highest PT,INR and D-D.Patients in the MDS group had the highest TT,and those in the SLE group had the highest APTT and FIB.The proportion of patients with an abnormally increased INR in the HM group was significantly higher than that of the ITP group and SLE group(P＜0.05).The proportion of patients with abnormally increased D-D in the HM group was significantly higher than that of the ITP group and AA group(P＜0.05).The detection rate of ITP and HM by bone marrow cytology was significantly higher than that by coagulation test,and the detection rate of ITP and HM by bone marrow cytology combined with coagulation test was significantly higher than a single examination(P＜0.05).The consistency between bone marrow cytology and coagulation test in the differential diagnosis of thrombocytopenia was 97.70％,with the Kappa value of 0.964(95％CI:0.818-1.110).Conclusion Bone marrow cytology and coagulation test have a certain detection rate in identifying the etiology of thrombocytopenia,and their combined examination is helpful to improve the detection rate and diagnostic value of thrombocytopenia etiology.