Background: Understanding the spectrum of hematological pathologies in pediatric patients through bone marrow aspiration provides crucial insights for diagnosis and treatment. This study aims to evaluate the clinico-hematological profiles and the prevalence of various hematological disorders in children undergoing bone marrow aspiration at a tertiary health care center. Methods: This cross-sectional descriptive study was conducted at a single tertiary care center and included a sample of 72 pediatric patients who underwent bone marrow aspiration over a one-year period. The study focused on assessing cellularity status and the presence of blast cells, alongside detailed clinico-hematological evaluations. Results: In a study of 72 pediatric patients at a tertiary care center, 52.7% exhibited hypercellularity, 25% normocellular, and 18.1% hypocellular during bone marrow aspiration. No significant associations were found between cellularity or the presence of blast cells (63.8%) and clinical features, indicating a potential for undetected malignant disorders. Conclusion: The study highlights the critical role of bone marrow aspiration in diagnosing serious hematological conditions in pediatric patients at a tertiary care facility. The high prevalence of blast cells suggests an urgent need for further diagnostic and therapeutic interventions. Future studies with larger sample sizes and broader geographic inclusion are recommended to validate and expand upon these findings, enhancing diagnostic accuracy and treatment strategies for pediatric hematological disorders.