Abstract
BackgroundPeripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. Only a few systematic studies have been published on the topic of pancytopenia, although extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Thus, this study was carried out to investigate for and to identify the causes of pancytopenia, to find out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our findings with those of other similar studies from this part of the world.MethodsThis was a prospective study conducted in the Department of Pathology of a teaching institute and a tertiary care hospital in southern Maharashtra, India, over a period of two years. All the patients referred to the central clinical laboratory for routine complete blood count (CBC) and peripheral smear (PS) examination, from both - the outpatient and the inpatient departments, were screened for pancytopenia. Of these, a total number of 250 cases that fulfilled the diagnostic criteria were selected.Detailed hematological investigations followed by bone marrow aspiration wherever indicated and possible were performed according to standard methods to ascertain the causes of pancytopenia.ResultsA definite male preponderance was observed, the male to female ratio being 2.6 : 1. The majority of cases were encountered in 3rd and 4th decades. Hypersplenism (29.2%), Infections (25.6%), Myelosuppressants (16.8%) and Megaloblastosis (13.2%) were the four most common causes in this large series on pancytopenia from a single centre in India.ConclusionDetailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause, avoiding a battery of unnecessary tests.
Highlights
Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes
Peripheral pancytopenia is reduction in all three major formed elements of blood to levels below their lower normal limit leading to simultaneous presence of anemia, leucopenia and thrombocytopenia
All the patients referred to the central clinical laboratory of the hospital for routine complete blood count (CBC) and peripheral smear (PS) examination, from the outpatient and the inpatient departments were screened for pancytopenia and a total number of 250 cases were selected, based on the criteria’s defined by deGruchy [1] as follows: 1) Hemoglobin (Hb.) level – below 13.5 g/L for males and below 11.5 g/L for females
Summary
Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. A few systematic studies have been published on the topic of pancytopenia, extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Peripheral pancytopenia is reduction in all three major formed elements of blood to levels below their lower normal limit leading to simultaneous presence of anemia, leucopenia and thrombocytopenia. It is not a disease entity by itself, but rather a triad of findings [1]. A look at literature shows that there aren’t many comprehensive studies on this subject from developed world, though extensive studies have been done for its individual etiological factors like aplastic anemia, megaloblastic anemia, leukemia, myelodysplastic syndrome, etc. The mechanism of development of pancytopenia varies from decrease in hematopoietic cell production as in aplastic anemia, trapping of normal cells in hypertrophied and overactive reticuloendothelial system as in hypersplenism, ineffective hematopoiesis in megaloblastosis or replacement by abnormal or malignant tissue in the marrow [1,2].
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