Case Of Pancytopenia Research Articles

When faced with macrocytic anemia in a pregnant woman, consider a vitamin B12 deficiency: About a case and review of the literature

The demonstration of a macrocytic anemia, especially aregenerative, during pregnancy, especially if associated with other abnormalities of other lineages (white blood cells and platelets) can be severe in pregnant women, hence the need to look for the causal condition which may be a deficiency cause especially in vitamin B12 or other more serious pathology. We report a case of pan cytopenia of deficiency origin during the 3rd trimester of pregnancy treated in our training. Pancytopenia of deficiency origin remains exceptional during pregnancy, especially in vitamin B12, and given its hemorrhagic and infectious severity, its discovery requires investigation and vitamin deficiency must be sought, particularly in the face of macrocytic anemia.

Bone marrow evaluation in a pediatric population with pancytopenia in a tertiary care children’s hospital of Nepal

Background: Pancytopenia, which is characterized by a triad of anemia, leukopenia, and thrombocytopenia, is frequently observed among the pediatric population. This study was carried out to determine the common etiologies of pancytopenia in children through bone marrow aspiration examination. Materials and methods: A one-year retrospective cross-sectional study of 64 cases of pancytopenia in the pediatric population was conducted at the Department of Pathology, Kanti Children’s Hospital, from July 2019 to June 2020. Results: 64 (35.55%) cases underwent bone marrow examination for pancytopenia. The patients' ages ranged from 4 months to 14 years, with a median age of 6.24±1.12 years. The majority of the patients fell into the age group of 1-5 years. The most common cause of pancytopenia was acute leukemia and hypoplastic bone marrow followed by erythroid hyperplasia, leishmaniasis, and megaloblastic anemia. Conclusions: Bone marrow examination is the fundamental diagnostic modality to diagnose the majority of cases of pancytopenia. It is important to consider acute leukemia, hypoplastic bone marrow, and leishmaniasis into account when evaluating pancytopenia in pediatric patients.

Etiology of pancytopenia with reference to bone marrow biopsy in a tertiary care hospital: A hospital-based study

Background: Pancytopenia is a common hematological entity and a striking feature of many life-threatening illnesses. Aims and Objectives: The study was conducted to identify the etiology of pancytopenia. (i) To find out primary bone marrow (BM) causes of pancytopenia. (ii) To evaluate the spectrum of BM morphology in pancytopenia cases. Materials and Methods: This hospital-based observational study was conducted between June 2021 and May 2022 in a tertiary care hospital in Dibrugarh in all pancytopenia cases of age above 12 years and meeting the inclusion criteria. After taking written consent, detailed history, clinical examination, and baseline investigations were done followed by BM examination. Results: Mean age was 45.39±15.49 years. Majority were males 41 (56.9%) and 31 (43.1%) were females. The most common cause of pancytopenia was Megaloblastic anemia (30.5%) cases, followed by aplastic anemia (18%) and myelodysplastic syndromes (16.7%). About 72 (100%) had pallor followed by weakness (86.1%), bleeding tendencies (70.8%), and fever (52.8%). Conclusion: The study underscores the critical role of BM biopsy in the diagnostic workup of pancytopenia. It confirms that BM biopsy is indispensable for identifying the diverse etiologies of pancytopenia and in implementing the appropriate therapy.

A study of etiological spectrum in 106 cases of pancytopenia

Introduction and aim. Pancytopenia is the simultaneous presence of anemia, leucopenia and thrombocytopenia. The aim of this work was to study the etiological spectrum of pancytopenia in the National capital region of India, and evaluate the relationship of pancytopenia with serum vitamin B12 levels. Material and methods. This study is of a prospective and analytical type conducted on patients attending the outpatient and inpatient department of Santosh Medical College and the Saraswathi Institute of Medical Sciences tertiary care centers in NCR. Complete blood counts and peripheral blood smear examination was used for morphological classification and typing of anemia. Bone marrow aspiration and vitamin B12 estimation was performed where required. Results. The maximum number of pancytopenia cases were etiologically attributed to megaloblastic anemia (64.2%) followed by aplastic anemia (19.8%). Malaria was attributed to 6.6% cases of pancytopenia. Iron deficiency anemia and tuberculosis both accounted for 1.9% of cases. each. A history of drug intake and mixed nutritional anemia each contributed to 2.8% of cases. Serum vitamin B12 levels showed a significant relationship with pancytopenic cases. Conclusion. In our study, the main cause of pancytopenia is megaloblastic anemia which responds very well to treatment if diagnosed correctly in time. A detailed hematological assessment along with vitamin B12 levels should be evaluated in all cases of pancytopenia irrespective of the etiological categorization.

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Background: Children who develop cytopenias present with several etiological causes, posing diagnosis, and management difficulties for both physicians and pathologists. With these in mind, we assessed the clinical profile and etiology of children who attended a healthcare facility in South India with bicytopenia or pancytopenia. Aims and Objectives: (1) The primary objective of this study was to find out the clinical and etiological spectrum in children with bicytopenia and pancytopenia who were admitted to the Institute of Child Health and Research Center, Government Rajaji Hospital, Madurai. (2) The secondary objective of this study is to follow-up children with bicytopenia and pancytopenia to find out the outcome and prognosis. Materials and Methods: This study was in the Department of Pediatrics at the Government Rajaji Hospital in Madurai, Madurai Medical College’s Institute of Child Health and Research Center, which is where we carried out the study. Two hundred and sixty-four patients with bicytopenia and 36 patients with pancytopenia were included in this study. Once in 2 weeks, all children with bicytopenia and pancytopenia were assessed in our Saturday hematology outpatient clinics. Results: Fever was the most prevalent sign of both pancytopenia and bicytopenia in this investigation. Etiological variables among cases of pancytopenia, cancer, infections, non-infections, and idiopathic causes were recorded in 11%, 58%, 17%, and 14% of cases, respectively. Similarly, bicytopenia, malignancy, infections, non-infections, and idiopathic causes were found in 23%, 70%, 4%, and 3% of cases, respectively. According to the prognosis, 28%, 33%, 6%, and 33% of cases with pancytopenia recovered, passed away, were lost to follow-up, or were undergoing treatment, respectively. Similar to those individuals, 67%, 11%, 4%, and 18% of bicytopenia cases were treated, recovered, or lost to follow-up, respectively. Conclusion: In children, there is a wide etiological range of cytopenias. Infections and dangerous diseases like acute leukemia are among the reasons. The geographical location of the hospital, the frequency of malnutrition, and the regional presence of certain diseases such as malaria and enteric fever determine the causes reported in a hospital environment.

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA). Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients. Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin <10 g/dL, total leukocyte count <4000/mm3, and platelet count <100,000/mm3 were included in this study. The patient’s posterior iliac crest was used for BMA. The Leishman stain was used to color BMA smears for microscopy. Results: This study comprised 51 cases of pancytopenia, with acute leukemia and megaloblastic anemia accounting for the majority (11 cases each out of 51), followed by dimorphic anemia (10/51), hypocellular marrow (9/51). The clinical symptom of generalized weakness and pallor was present in all instances (100%) and was followed by fatiguability (72%) and dyspnea (48%). The last two least frequent symptoms, lymphadenopathy, and hepatomegaly, were also present in many patients. A significant proportion of pancytopenia individuals experienced lymphadenopathy and hepatomegaly, which were the last two least prevalent appearances. Conclusion: In most cases, bone marrow aspiration in pancytopenia patients aids in determining the underlying reason. Understanding the illness process, planning future research, and managing cytopenia patients can all benefit from it.

Pancytopenia Caused by Nitrous Oxide Toxicity: Two Cases Report

Recreational nitrous oxide (N2O) is increasingly common among young people, leading to attendant health disadvantages. Related complications primarily involve the hematological and neurological systems. We report two relatively uncommon cases of pancytopenia due to substantial N2O inhalation. One possible cause is that N2O toxicity results in vitamin B12 inactivation and an insufficient intake of nutrients. The patient’s symptoms partially improved after cessation of N2O inhalation and supplementation with vitamin B12. In conclusion, if the patients presented with unexplained bone marrow failure, a history of prolonged N2O exposure should be considered, which would greatly help in early diagnosis, therapy, and the reduction of unnecessary costs.

Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia. : The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.

Polymorphonuclear-Mononuclear Ratio in Peripheral Blood as Hematologic Malignancy Predictor in Pancytopenia

Pancytopenia is a laboratory finding of decreased hematological cells characterized by hemoglobin of <13.5 g/dL for males or <11.5 g/dL for females, leukocytes of <4x109/L and platelets of <150x109/L. The data from Dr. Moewardi Hospital reported 56 cases of pancytopenia in 2020. Follow-up tests such as reticulocyte test, Bone Marrow Puncture (BMP), or bone marrow biopsy are needed to determine the cause of pancytopenia. This study aimed to assess the performance of the Pm/M ratio of peripheral blood as a screening instrument to predict the cause of pancytopenia. A cross-sectional study was carried out on pancytopenia patients undergoing laboratory tests at the Clinical Pathology Laboratories of Dr. Moewardi Hospital from January 2020 to June 2021. The cut-off point of the Pm/M ratio was determined by ROC and AUC curves. The results were presented in a 2x2 table. The Pm/M ratio <0.91 as a predictor of hematological malignancy had a sensitivity of 82.9%, specificity of 82.9%, PPV 82.9, NPV 82.9%, LR positive 4.833 and LR negative 0.207. The Pm/M ratio can be used as a screening biomarker to predict the cause of pancytopenia before performing BMP and to distinguish between hematological malignancy and non-hematological malignancy.

A case where the histiocytes helped thread those crystalline needles

Plasma cell neoplasms involve excessive immunoglobulin (Ig) secretion which is the main culprit. Hence, they are the most sought after cells in bone marrow whenever plasma cell dyscrasias is suspected. In their absence, the diagnosis becomes questionable. However, if one can identify those Igs disguising themselves as crystals in histiocytes, the path becomes clearer. We present one such case of pancytopenia where an incidental finding of these crystal storing histiocytes helped clinch the diagnosis of a monoclonal gammopathy which was otherwise suspected to be a consequence of anti-tuberculous therapy.

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India.

Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin. Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. Severeiron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopeniaif common causes of pancytopenia are ruledout.

FREQUENCY OF CAUSES OF PANCYTOPENIA IN BONE MARROW SAMPLES OF PATIENTS

Objective: The aim of this study is to find out the common causes that lead to pancytopenia in our population specially in the province of Punjab. Material and Methods: This is a cross sectional study that was conducted at Chughtai Institute of Pathology, Lahore. The duration of the study was from June 2020 to December 2021. A total of 210 patients were included in the study. A through history was taken and complete physical examination was done prior to the bone marrow biopsy procedure. Peripheral blood sample was run on Sysmex XN 9000 automated hematology analyzer. Bone marrow aspirate and trephine biopsy were thoroughly examined and immunohistochemical stains were applied where required. The data was analyzed using SPSS 23.0 and frequencies were calculated. Results: Most common causes of pancytopenia in our study were megaloblastic anemia (18.1%) followed by aplastic anemia (12.9%), immune mediated causes (12.4%), acute myeloid leukemia (11%), hypocellular marrow (9%) myelodysplastic syndrome (6.2%), hypersplenism (5.2%) and Precursor B acute lymphoblastic leukemia (5.2%) (Fig. 2). Other causes include B cell non-Hodgkin lymphoma (4.8%), mixed deficiency anemia (4.2%), hypersplenism (3.8%), Gaucher’s disease (1.4%), infections (1%) and other miscellaneous causes (4.8%). Conclusion: The study conducted at our institute showed that majority of patients had benign causes (69.2%) leading to pancytopenia, the most common cause being megaloblastic anemia. Malignant causes constitute only a minority of cases of pancytopenia. Key Words: Bone marrow biopsy, Frequency, Pancytopenia

Pancytopenia as Another Collateral Damage of Covid-19 Infection in a Previously Healthy Child

Aim and Background: Pancytopenia is a reduction of all the three cells of peripheral blood lineage: leukocytes, erythrocytes and platelets. The bone marrow can be primarily hypocellular in pancytopenia either due to reduction of hematopoietic cell production or ineffective haemopoiesis. Generally, infections, toxins or malignant transformation of the marrow are responsible for most of the cases of pancytopenia.1 After the incidence of Covid-19 pandemic, pancytopenia has been seen to occur as a rare complication secondary to SARS-COV 2. Here, we report a unique case of pancytopenia in a previously healthy child with SARS-CoV-2 infection.

Ramifications of Pancytopenia in Children in a Tertiary Care Center in North Indian

BACKGROUND: Pancytopenia generally suggests the likelihood of bone marrow failure syndromes or leukemias. However, other easily treatable entities can also cause pancytopenia. To know the underlying cause of pancytopenia is essential for definite management and prognosis. AIM: The aim of this study is to study the prevalence, clinico-hematological profile, and etiology of pancytopenia in hospitalized children of 1 month to 18 years of age. METHODS: Descriptive study conducted in a tertiary care center included children of age 1 month to 18 years hospitalized with pancytopenia. Sociodemographic data, presenting complaints, and detailed history were noted. Detailed clinical examination and relevant investigations were done. RESULTS: The prevalence of pancytopenia was 2%. Majority of the patients were >10 years of age. Female: Male ratio was 1.15:1. The most common presentation was progressive pallor, followed by fever, icterus, and bleeding manifestations. The most common clinical examination finding was pallor, followed by splenomegaly, hepatomegaly, icterus, and lymphadenopathy. Macrocytic blood picture was most common, followed by microcytic, atypical cells, and normocytic picture. Mean serum ferritin (ng/ml) was 374.77 ± 1662.64. Mean serum B12 (pg/ml) was 117.72 ± 64.71. In bone marrow aspirate examination, megaloblastic erythropoiesis was most common, followed by normoblastic erythropoiesis, dual deficiency, malignant cells of lymphoid series, hypocellular marrow, and malignant cells of myeloid series. Megaloblastic anemia was the most common etiology, followed by dimorphic anemia amid acute leukemia. CONCLUSION: The study showed that megaloblastic anemia and infections (tuberculosis, dengue fever, and enteric fever) both of which are eminently treatable, cause nearly 65% of pancytopenia cases in pediatric patients.

PATHOLOGICAL EVALUATION OF BONE MARROW BIOPSY IN PANCYTOPENIA CASES WITH SPECIAL REFERENCE TO BONE MARROW IMPRINT CYTOLOGY: A HOSPITAL BASED STUDY

Introduction: Pancytopenia is an important clinico-hematological condition and mainly presents in the form of anemia, leucopenia and thrombocytopenia. There are varying trends in its clinical patterns, treatment modalities and outcome. A hospital-based Materials and Methods: observational study was done in the department of Pathology, AMCH, Dibrugarh, Assam, from June 2021-May 2022 in patients above 12 years admitted in Medicine ward fullling the inclusion criteria were included in this study. All the participants underwent detailed clinical examinations and baseline investigations followed by bone marrow examinations. Out of 72 participa Results: nts, 41 were males and 31 were females with male to female ratio of 1.32:1. Mean age was 45.39 ± 15.49 years. Megaloblastic anemia was the commonest cause that was observed in 30.5% (22) cases followed by Aplastic anemia 18% (13) and MDS 16.7% (12). Anisocytosis, reticulocytosis and hypercellular marrow were the most common hematological picture. The severity of pancytopenia and underlying pathology determines Conclusion: the management and prognosis. Thus, comprehensive clinical and hematological evaluation of pancytopenia cases is utmost necessary to identify the correct cause

An Interesting Case of Pancytopenia

An Interesting Case of Pancytopenia

A confounding case of pancytopenia

Tuberculosis is one of the major health problems in the developing countries like India. Due to its nonspecific presentation, extra pulmonary TB is diagnosed at later stages.It is an important differential diagnosis for pyrexia of unknown origin (PUO). A 54-year-old male came to hospital with complaints of fever, pain abdomen (on and off), easy fatiguability, reduced appetite, weight loss, breathlessness on exertion for 8 months who completely recovered after starting anti-tubercular therapy.

Subleukemic leukemia presenting as pancytopenia in an elderly female with mild constitutional symptoms: A rare case report

Subleukemic leukemia is characterized by the presence of atypical or abnormal white blood cells in peripheral blood with total leukocyte count in within normal range. The clinical features are nonspecific and include fever, fatigue, and weight loss, vague bone pain, bruising or bleeding. We present a rare case of subleukemic leukemia presenting as pancytopenia in a 55 years female, who presented with mild constitutional symptoms of generalized weakness, easy fatiguability and loss of appetite for the past 3 months. We should be aware of this rare finding of subleukemic leukemia in patients with mild constitutional symptoms and keep it in the differentials of a case of pancytopenia, for prompt diagnosis and early initiation of treatment, with better outcome.

Clinicopathological Features of Pancytopenia in Adults and the Role of Bone Marrow Study in Etiological Categorization

Background and Objectives: Pancytopenia is a combination of anemia (with a reduction of the red blood cell count), leukopenia, and thrombocytopenia. Leukopenia is usually mainly due to a reduction in the neutrophil count although the number of other granulocytes, monocytes, and lymphocytes are often also reduced. Pancytopenia is a manifestation of many serious and life-threatening diseases. This study was undertaken to evaluate the clinicopathological features of pancytopenia and the role of bone marrow study for etiological categorization. Settings and Design: This is a cross-sectional observational study conducted in a tertiary referral center of north east India, for a period of 1 year (from August 2020 to July 2021). Materials and Methods: Proper history taking and clinical examination were done for all patients attending with hemoglobin <10 mg/dL, total leukocyte count <3000 cells/cmm, and platelet count <1 lakh/cmm. The investigations done were peripheral blood smear examination with Leishman stain, special staining, as well as specific biochemical and radiological investigations as per requirement in cases; bone marrow aspiration (under all aseptic precaution); and bone marrow trephine biopsy (under all aseptic precaution). The results are presented in tables and compared with similar studies. Results: A total of 42 cases of pancytopenia were evaluated. The age group of 18–20 years was the most commonly affected. Male-to-female ratio was 1.33:1. All the patients presented with generalized weakness and pallor, and a large portion also with abdominal discomfort, hepatomegaly, and splenomegaly. Anisocytosis and macrocytosis were the most common peripheral blood smear findings. Vitamin B12 level was decreased in 75% of all the evaluated cases (15 of 20 cases). Bone marrow was hypercellular in most of the cases (80.95%) followed by hypocellular marrow (14.29%). Megaloblastic erythroid hyperplasia was the most common abnormality found in bone marrow. Megaloblastic anemia was the most common etiology followed by hypoplastic/aplastic anemia. A significant portion (7.14%) also showed bone marrow involvement by myeloma. One case of involvement by metastatic tumor was found. Conclusions: Most cases of pancytopenia were due to megaloblastic anemia and so easily curable. The bone marrow study is essential to evaluate a case of pancytopenia to know the exact etiology for proper management.

Aetiology of pancytopenia: Experience of a South African tertiary academic centre

BackgroundPancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis.ObjectiveThis study aimed to determine the aetiology of pancytopenia in a South African population.MethodsA retrospective observational study of adult patients presenting with pancytopenia at Tygerberg Academic Hospital, South Africa, from January 2016 to December 2017 was performed. Data on pancytopenia cases were obtained from the laboratory information system and utilised to determine the causes of pancytopenia.ResultsA total of 673 cases of pancytopenia were identified. The most common causes of pancytopenia were chemoradiation therapy (25%), sepsis (18%), haematological malignancy (9%), advanced HIV (7%), and megaloblastic anaemia (6%). The diagnostic yield of bone marrow examinations (BME) was 57% (n = 52/91). The aetiology of pancytopenia differed according to age, with malignancy being a more common cause of pancytopenia among the elderly.ConclusionSeveral easily recognisable and treatable conditions can manifest as pancytopenia. Prompt management of such conditions, notably sepsis and megaloblastic anaemia, can result in the resolution of the cytopenias and negate the need for a BME. However, haematological malignancy and unexplained pancytopenia strongly rely on a BME to establish a diagnosis. Pancytopenia investigations, when guided by appropriate clinic-laboratory findings, can promptly identify the underlying aetiology, while also identifying cases where an expedited BME is required. This is valuable in resource-conscious medicine.