Cytomorphological evaluation of bone marrow aspirate smears fixed with graded honey at a tertiary hospital in Kenya

Abstract

Bone marrow aspirate cytology depends on preservation of nuclear and cytoplasmic features for microscopic assessment. Honey has been investigated as a naturally derived fixative, but evidence for bone marrow aspirate smears and for the effect of honey concentration is limited. Objective: To evaluate cytomorphological characteristics of bone marrow aspirate smears fixed using 50%, 70%, and 100% honey. Methods: A laboratory-based comparative experimental study was conducted at the Histopathology Laboratory of Moi Teaching and Referral Hospital/AMPATH, Eldoret, Kenya. The final analytical dataset comprised 99 routine diagnostic specimens. Additional smears were fixed with 50%, 70%, or 100% honey and stained using May–Grünwald–Giemsa. Two blinded pathologists independently assessed five domains on a 0–4 scale. Results: Mean overall scores were 2.3 (SD 0.48), 2.1 (SD 0.52), and 1.9 (SD 0.59) for 100%, 70%, and 50% honey, respectively. The highest domain scores were observed with 100% honey and the lowest with 50% honey. Reported nuclear adequacy was 83.8%, 78.8%, and 72.7%, respectively. Conclusion: The results show a descriptive concentration-associated trend, with undiluted honey receiving the highest ratings among the preparations evaluated. Scores were moderate and variable; the results do not establish diagnostic equivalence or suitability for routine use. Further studies should validate standardized honey preparations against a conventional fixative using adequately powered, preferably multi-centre designs, explicit adequacy criteria, and measures of interobserver agreement and diagnostic performance. Until then, honey should not be assumed to replace conventional fixation in routine diagnosis.