Clinico-Hematological Study of Pancytopenia Using Bone Marrow Aspiration and Trephine Biopsy

Background: Pancytopenia is a significant hematological disorder marked by reduction of all three peripheral blood cell lines. It causes range widely from reversible nutritional deficiencies and infections to bone marrow failure syndromes and hematological malignancies. Clinical presentation is often nonspecific, making early diagnosis challenging. While peripheral blood examination offers initial clues, definitive diagnosis frequently requires bone marrow evaluation. Bone marrow aspiration and trephine biopsy, provide comprehensive assessment of marrow morphology and cellularity, aiding precise etiological diagnosis and guiding management. Methods: This cohort study was conducted over one year at a tertiary care center, enrolling 160 patients with pancytopenia. All patients underwent clinical evaluation, complete blood count, and peripheral smear examination. Bone marrow aspiration was performed in all cases, while trephine biopsy when indicated. Aspirate smears were stained with Leishman stain, and biopsy sections with hematoxylin and eosin. Findings were correlated with clinical and hematological parameters. Results: The study cohort demonstrated a slight male predominance (53.12%). Hypercellular marrow was frequent pattern (48.12%), followed by hypocellular (30.62%) and normocellular marrow (21.25%). A dimorphic blood picture was the most common peripheral smear finding (28.75%). Nutritional anemia constituted the leading etiology, with megaloblastic anemia accounting for 15.62% of cases and combined nutritional deficiency for 12.5%. Aplastic anemia was identified in 7.5% of cases and was more reliably diagnosed on trephine biopsy. Acute leukemias comprised 8.75% of cases. Dry tap was encountered in 3.75% of aspirations. The combined use of bone marrow aspiration and trephine biopsy yielded an overall diagnostic accuracy of 93.75%. Conclusions: Pancytopenia demonstrates a broad, heterogeneous etiology, with nutritional deficiencies being the predominant cause in this study. Bone marrow aspiration and trephine biopsy are complementary diagnostic modalities, and both enhances diagnostic precision, particularly in hypocellular marrow and unsuccessful aspiration. Early, accurate bone marrow evaluation remains essential for timely diagnosis and appropriate  management.