An evaluation of pancytopenia in peripheral BLOOD smears

Abstract

Background: This study is designed to find out the pathological spectrum of pancytopenia in patients suffering from hematological disorders. Aims: To identify the common hematological disorders producing pancytopenia. Setting And Design The present study was done in the Department of pathology, Gandhi Medical College and associated Hamidia hospital,Bhopal M.P. A total of 3 consecutive prospective cases were studied. Method and Material: Patient’s Selection criteria our study included all the patients who were admitted in Hamidia hospital with a clinical suspicion of a hematological disorder and demonstrating pancytopenia in the peripheral blood smears. OPD patients on clinical suspicion of a hematological disorder by the consultant incharge were also included in the study group after obtaining their detailed history, clinical examination and all other relevant investigations. Patients with highly increased bleeding time and clotting time were deterred from the study. Procedure to find out the cause of pancytopenia, bone marrow aspiration was done from Manubrium of the Sternum after injecting 2% xylocaine to the part in addition to sedation with diazepam in uncooperative patients and in small children. Bone marrow smears were prepared and stained with Leishman stain along with the simultaneous staining of the peripheral smears. A complete hemogram including Hb%, PCV, Red cell indices, platelet count, total leucocyte count and differential leucocyte count was also done by automated cell counter. Finally, the bone marrow and peripheral smears were examined manually under oil immersion. Statistical analysis Bone marrow aspiration was done in 135 patients including children suspected to be suffering from some kind of hematological disorder. Out of the total patients who were advised bone marrow aspiration to arrive at conclusive diagnosis around 21% had pancytopenia under evaluation on peripheral smear examination. In adults, Megaloblastic anemia was the leading cause of pancytopenia followed by Hypo plastic marrow while in pediatric population Hypo plastic marrow topped the list followed by anemias. Results: Pancytopenia is not an uncommon hematological diagnosis. The investigation of choice in all the cases of pancytopenia is Bone marrow aspiration which proved to be conclusive in almost 100% of the cases. Megaloblastic anemia in adults and Hypo plastic marrow in children were the leading causes producing pancytopenic blood picture. Keywords: Pancytopenia, Bone Marrow Aspiration, Megaloblastic Anemia, Hypo plastic Marrow