Abstract
This study was carried to identify the causes of pancytopenia and to find out the bone marrow morphology in cases of pancytopenia. It was a cross sectional study conducted over a period of two years in the Department of Pathology, Tribhuvan University Teaching Hospital. Bone marrow aspiration smears of patients fulfilling the criteria of pancytopenia were examined. The data obtained were analyzed using measures of central tendency. One hundred and forty eight cases underwent bone marrow aspiration and it constituted 15.74% of total cases. Mean age was 30 years (range, 1-79 years). 42 cases were children (28.37%). Male: female ratio was 1.5:1. The commonest cause was hypoplastic bone marrow seen in 43 cases (29%) followed by megaloblastic anemia in 35 cases (23.64%), and hematological malignancy in 32 cases (21.62%). Erythroid hyperplasia was seen in 29 cases (19.6%) and normal bone marrow was seen in 5 cases (3.38%). There was one case each of Niemann-Pick disease and metastatic neuroblastoma in children and chronic pure red cell aplasia and leishmaniasis in adults. Acute leukemia was the commonest hematological malignancy. In children, commonest finding was hypoplastic bone marrow (38.1%) while in adults megaloblastic anemia (30.18%) was commonest finding followed by hypoplastic anemia (25.47%). In present study bone marrow examination was able to establish diagnosis in 77% of cases. Hypoplastic marrow was the commonest diagnosis, followed by megaloblastic anemia, and hematological malignancies.
Highlights
Pancytopenia is defined by reduction of all the three formed elements of blood below the normal reference range.[1]
The underlying mechanisms are decrease in hematopoietic cell production, marrow replacement by abnormal cells, suppression of marrow growth and differentiation, ineffective hematopoiesis with cell death, defective cells formation which are removed from the circulation, antibody mediated sequestration or destruction of cells, and trapping of cells in a hypertrophied and overactive reticuloendothelial system. 1, 3
Cases fulfilling the definition of pancytopenia but lacking marrow representative bone marrow in the marrow aspirate were excluded from the study
Summary
Pancytopenia is defined by reduction of all the three formed elements of blood below the normal reference range.[1] The presenting symptoms are often attributable to the anemia or the thrombocytopenia. The underlying mechanisms are decrease in hematopoietic cell production, marrow replacement by abnormal cells, suppression of marrow growth and differentiation, ineffective hematopoiesis with cell death, defective cells formation which are removed from the circulation, antibody mediated sequestration or destruction of cells, and trapping of cells in a hypertrophied and overactive reticuloendothelial system. In cases of ineffective hematopoiesis the marrow may be normocellular or hypercellular.[1] Bone marrow examination is extremely helpful in evaluation of pancytopenia.[4] Few similar studies have been published in the country.[5] This study was carried out with an aim to obtain further information so that it would help in the management of patient with pancytopenia
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