Clinicohematological Profile of Pancytopenia: A Study from a Tertiary Care Hospital

Abstract

Objective: Pancytopenia is a clinicohematological problem with wide spread discriminated diagnosis. A through evaluation of patient is necessary to identify the cause as large number of patients has reversible etiology and early diagnosis may be lifesaving. Diagnosis of pancytopenia requires microscopic examination of bone marrow aspirates to assess the overall cellularity and morphology. This study was conducted with the aim to find out the cause of pancytopenia on the basis of bone marrow findings.
Methods: The present study was conducted in the department of pathology over a period of one year. A total of 169 patients were included in the study that fulfilled the criteria of pancytopenia. A detailed clinical history and physical examination followed by complete blood count, peripheral smear examination and bone marrow aspiration was done in all cases.
Results: There was slight male predominance with male to female ratio of 1.2:1. The majority of patients were in second and third decade. The main cause of pancytopenia was megaloblastic anemia followed by mixed nutritional deficiency anemia and others.
Conclusion: This study emphasized that in developing countries like India majority of the patients had reversible etiology and patients can be put on a trial of hematinics and close haematological follow up.
Key words: Pancytopenia, bone marrow, megaloblastic anemia, aplastic anemia

Keywords

• -

Pansitopeninin Klinik ve Hematolojik Profili: Bir Üçüncü Basamak Hastane Çalışması

Abstract

Amaç: Pansitopeni geniş bir ayırıcı tanı yelpazesi olan klinik ve hematolojik bir problemdir. Hastaların detaylı bir incelemesi gerekmektedir çünkü etiyolojide geri dönüşümlü bir etiyoloji olabileceği gibi erken patolojinin hayat kurtaracağı ciddi bir patolojide sorumlu olabilir. Pansitopeni tanısında kemik iliğinin hücresel ve morfolojik incelenmesi için kemik iliği aspirasyonu gerekmektedir. Bu çalışma, kemik iliği bulguları temelinde pansitopeninin nedenini bulmak amacıyla yapılmıştır. Yöntemler: Bu çalışma bir yıl süre içinde patoloji bölümünde gerçekleştirilmiştir. Pansitopeni kriterlerini karşılayan 169 hasta çalışmaya dahil edildi. Tüm olgularda, tam kan sayımı, periferik yayma incelemesi ve kemik iliği aspirasyonu takiben ayrıntılı klinik öykü ve fizik muayene yapıldı.Bulgular: Erkek kadın oranında erkek lehine hafif bir baskınlık vardı: 1/1.2. Hastaların büyük bir çoğunluğu, 10 lu ve 20 li yaşlarındaydılar. Pansitopenin ana nedeni megaloblastik anemi ve ardından beslenme yetersizliği anemisi ve diğer nedenler olarak görüldü.Sonuç: Bu çalışma göstermiştir ki Hindistan gibi gelişmekte olan ülkelerde pansitopeni etiyolojisi çoğunlukla geri dönüşümlü nedenlere bağlıdır ve bu ülkelerde hastalara kan yapıcı vererek yakın hematolojik takipleri önemlidir

Keywords

• Pansitopeni, kemik iliği, megaloblastik anemi, aplastik anemi

References

1. Raz I, Shinar E, Polliack A. Pancytopenia with hypercellular bone marrow a possible paraneoplastic syndrome in carcinoma of lungs: a report of three cases. Am J Hematol 1984;16:403-408.
2. De Gruchy GC: Pancytopenia; Aplastic anemia. In Firkin F,
3. Chestermann C, Penington D (eds). De Gruchy’s Clinical Haematology in Medical Practice.5th edition. Oxford University
4. Press. 1991:p: 119-136.
5. Chhabra A, Chander V, Patel A, et al. Clinico-aetiological profile of pancytopenia in paediatric practice. J Indian Acad Clin Med 2012;13:282-285.
6. International Agranulocytosis and Aplastic Anaemia Study group: Incidence of aplastic anaemia: the relevance of diagnostic criteria. Blood 1987;70:1718-1721.
7. Verma N, Dash S. Reappraisal of underlying pathology in adult patients presenting with pancytopenia. Trop Geog Med 1992;44:322-327.
8. Jain and Naniwadekar. An etiological reappraisal of pancytopenia-

9. largest series reported to date from single tertiary care teaching hospital. BMC Hematology 2013;13:10.Doi:10.1186/2052-1839-13-10
10. Naseem S, Varma N, Das R, et al. Paediatric patients with bicytopenia/pancytopenia: review of aetiologies and clinicohaematological profile at a tertiary centre. Indian J Pathol
11. Microbiol 2011;54:75-80.
12. Bunch C. Bone marrow failure. Med Int 1995;10:495-499.
13. Jha A, Sayami G, Adhikari RC, et al. Bone marrow examination
14. in cases of pancytopenia. J Nepal Med Assoc.2008;47:12-17.
15. Kumar R, Kalra SP, Kumar H, et al. Pancytopenia-a six year
16. study. J Assoc Physicians India 2001;49:1078-1081.
17. Khodke K, Marwah S, Buxi G, et al. Bone marrow examination
18. in cases of pancytopenia. J Indian Acad Clin Med 2001:2:55-59.
19. Tilak V, Jain R. Pancytopenia-a clinicohematological analysis
20. of 77 cases. Indian J Pathol Microbiol 1999;42:399-404.
21. Chandra J, Jain V, Narayan S, et al. Folate and cobalamin deficiency in megaloblastic anemia in children. Indian Pediatr 2002;39:453-457.
22. Jan MA.Thrombocytopenia in children. J Postgrad Med Inst 2004;18:353-358.
23. Menon S, Shaikh S, Nizamani MA. Etiological spectrum of
24. pancytopenia based on bone marrow examination in children.
25. J Coll Physicians Surg Pak 2008;18:163-167.
26. Khan FS, Hasan RF. Bone marrow examination of pancytopenic
27. children. J Pak Med Assoc 2012;62:660-663.
28. Imbert M, Scoazec JY, Mary JY, et al. Adult patients presenting
29. with pancytopenia: A reappraisal of underlying pathology and diagnostic procedures in 213 cases. Hematol Pathol 1989;3:159-167.
30. Keisu M, Ost A. Diagnosis in patients with severe pancytopenia
31. suspected of having aplastic anemia. Euro J Haematol 1990;45:11-14.
32. Khunger JM, Arun selvi S, Sharma U, et al. Pancytopenia-a
33. clinicohematological analysis of 200 cases. Indian J Pathol Microbiol 2002;45:375-379.
34. Latger Cannard V, Bibes B, Dao A, et al. Malaria related
35. cytopenia. Ann Biol Clin 2002;60:213-216.
36. Aouba A, Noguera ME, Clawel JP, et al. Haemophagocytic syndrome associated with plasmodium vivax infection. Br J Haematol 2000;108:832-833.
37. Modan B, Segal S, Shani M, et al. Aplastic anemia in Israel:
38. evaluation of the etiological role of chloramphenicol on a community wide basis. Am J Med Sci 1975;270:441-445.