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.

Keywords: anemia; bone marrow examination; chronic kidney disease (ckd); dyspoiesis; hematopoiesis; plasma cell disorders.

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背景：本研究旨在描述印度比哈尔邦慢性肾病（CKD）患者骨髓的特征，并确定这些发现与患者的临床表现和血液学参数之间的相关性。具体而言，本研究旨在： 1. 记录CKD患者骨髓异常的患病率及模式， 2. 分析骨髓发现与CKD分期之间的关联， 3. 研究骨髓变化与血液学参数（包括贫血严重程度和形态）之间的关系。 方法：通过分析在印度比哈尔邦一家三级医疗机构住院的220例CKD患者的骨髓结果，进行了一项回顾性观察研究。记录了患者的人口统计信息、临床特征及实验室数据，包括全血细胞计数、外周血涂片、肾功能测试和血清蛋白电泳。利用标准技术进行了骨髓穿刺和活检，并由两名独立的血液病理学家进行分析。对CKD分期、贫血严重程度、骨髓发现及其他临床参数之间的相关性进行了数据分析。 结果：研究人群主要为中年男性（63.2%），高血压负担高（90%）且糖尿病患病率较高（46.4%）。所有患者均出现贫血症状，其中中度贫血最常见（45.9%），正色素、正常红细胞亚型最普遍（48.6%）。骨髓检查显示，在44.1%的病例中三系造血正常。其他值得注意的发现包括浆细胞增多（23.2%）、红系增生（17.7%）及不全造血特征（8.2%）。更晚期阶段的CKD与更高比例的浆细胞异常和不全造血特征、红系增生以及更低比例的正常造血相关。需要透析治疗的患者比不需要透析的CKD患者骨髓异常的发生率更高。 结论：本研究为比哈尔邦CKD患者的骨髓变化建立了参考标准，并展示了超出单纯肾性贫血之外的复杂血液学变化谱系。浆细胞紊乱和不全造血改变在晚期CKD中的高发强调了对未诊断细胞减少症及疑似单株球蛋白血症患者进行骨髓检查的重要性。

关键词： 贫血；骨髓检查；慢性肾病（CKD）；不全造血；造血；浆细胞紊乱。

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