ĐẶC ĐIỂM TỦY ĐỒ CỦA HỘI CHỨNG SUY TỦY XƯƠNG TẠI BỆNH VIỆN NHI ĐỒNG I

Abstract

Bone marrow failure is a syndrome characterized by impaired hematopoietic stem cell production in the bone marrow, resulting in peripheral pancytopenia. Cytological abnormalities observed on bone marrow smears, such as hypocellularity, dysplasia, and the presence of abnormal cells, may provide valuable clues to underlying marrow pathologies, including aplasia. This study aimed to address the question: What is the cellular density distribution of granulocytic, erythroid, and megakaryocytic lineages on bone marrow smears in pediatric patients with bone marrow failure? Objective: To determine the cellular density of hematopoietic lineages on bone marrow smears in children with aplastic anemia syndrome and to recognize the correlation between erythroid lineage density and reticulocyte percentage (RET%). Subjects and Methods: A descriptive case series was conducted on 21 pediatric patients diagnosed with aplastic syndrome at Children’s Hospital 1 between January and April 2025. Bone marrow aspirate smears were analysed cytologically to quantify cellular densities across three hematopoietic lineages. RET% was concurrently measured using an automated haematology analyser. Results: The granulocytic lineage showed a decreased density, with a median neutrophil proportion of 24% (14-37.5%), while lymphocytes were elevated at 44% (27-69%). The erythroid lineage was predominantly arrested at the Orthochromic normoblast stage in 85.7% of cases, yet overall erythroid density was low. Megakaryocytes were present in only 57.1% of cases, with widely variable densities (5-300/mm²). No significant linear correlation was found between RET% and Orthochromic normoblast density (R² = 0.0023). Conclusion: Cellular density abnormalities on bone marrow smears support the diagnosis of pediatric aplastic syndrome. While RET% may serve as an indirect indicator of erythropoietic activity, it cannot replace marrow cytology. Further large-scale studies are needed to validate this association.