Cause Of Pancytopenia In Patients Research Articles

To Determine the Common Causes Leading to Pancytopenia in Patients Presenting to Tertiary Care Hospital, Lahore

Background: New-onset pancytopenia can be caused by a wide variety of etiologies, leading to an array of prolonged and invasive investigations. Knowing the important differentials can help in targeted screening and early diagnosis. The reported frequency of common causes of pancytopenia varies among existing studies due to population and geographic differences in dietary habits and environmental and genetic factors, thus necessitating the present study. The goal is to determine the frequency of the leading causes of pancytopenia in patients presenting to the hospital. Subjects and methods: This study is a cross sectional study involving 140 patients of both genders aged between 12 to 80 years presenting with pancytopenia to Sir Ganga Ram hospitals, Lahore. These patients underwent detailed clinical and lab evaluation to identify the underlying cause of pancytopenia e.g. aplastic anemia, megaloblastic anemia, hypersplenism and acute leukemia. The etiological spectrum of pancytopenia was stratified by various subgroups of patients based on age and gender. A written informed consent was taken from each patient. Results: The mean age of the patients was 47.2±19.9 years. There were 90 (64.3%) male and 50 (35.7%) female patients in the study group with a male to female ratio of 1.8:1. Among the underlying causes of pancytopenia, aplastic anemia was most frequent and was observed in 54 (38.6%) patients followed by megaloblastic anemia (n=39, 27.9%), hypersplenism (n=24, 17.1%) and acute leukemia (n=23, 16.4%). Upon stratification, no statistically significant difference was observed in the frequency of various underlying causes of pancytopenia across various subgroups of patients based upon age and gender. Conclusion: In the present study, aplastic anemia and megaloblastic anemia were found as the most frequent cause underlying pancytopenia regardless of patient’s age and gender. This advocates their consideration as important differentials in the diagnostic evaluation of patients presenting with pancytopenia in future medical practice so that timely identification and management may improve the outcome of such cases. Keywords: Pancytopenia, Etiological Spectrum, Aplastic Anemia, Megaloblastic Anemia

Pancytopenia: Clinical and Haematological Profile from a Tertiary Care Centre in Central India

Introduction: Pancytopenia is a characterised by the decrease in number of red blood cells, white blood cells, and platelets. It is not a final diagnosis; instead, a manifestation of underlying haematological and other disorder. No study has been carried out to evaluate the cause of pancytopenia from this region. The majority of the Western world studies suggest aplastic anaemia as a significant cause of pancytopenia. However in India, the pancytopenia causes are not well defined and varied. Earlier studies from India show megaloblastic anemia being the primary cause of pancytopenia. Aim: To investigate the clinical and haematological correlation of pancytopenia and to ascertain aetiopathological causes of pancytopenia in patients admitted to a tertiary care center. Materials and Methods: This prospective cross-sectional study was conducted from August 2012 to August 2014 at RD Gardi Medical College, Ujjain, a total of 100 consecutive patients with two or all three of the following inclusion criteria were enrolled: Haemoglobin <10 gm/dL Total Leukocyte Count (TLC) <4000/μL and platelet count <1,00,000/μL. All patients underwent complete hemogram, peripheral smear, and reticulocyte count evaluation. Bone marrow aspiration was also performed in all patients, and in addition, a trephine biopsy was done in the same setting in 23 patients. Data were analysed using standard statistical methods. Various sign, symptoms of pancytopenia were recorded and analysed. Results: Underlying cause of pancytopenia was ascertained with the help of blood picture of bone marrow aspiration and biopsy, fatigue was the most common symptom (54%) followed by fever (49%) and breathlessness (15%). Pallor was detected in 85% of patients, splenomegaly in 47%, followed by hepatomegaly, oedema, lymphadenopathy, icterus, and ascites. Megaloblastic anemia was found to be the most prevalent cause of pancytopenia, which was seen in 49% of patients and followed by hypersplenism (16%). Conclusion: Pancytopenia is not an uncommon condition and should be suspected on clinical grounds when a patient presents with unexplained anaemia, fatigue and prolonged fever. Along with the clinical examination, the haematological study includes peripheral smear, bone marrow aspiration and bone marrow biopsy plays a critical role in the diagnosis.

Study on Diagnostic Evaluation of Pancytopenic Patients

Introduction: Pancytopenia is a common hematological problem with an extensive differential diagnosis and is a challenging problem to the treating physician. Bone marrow aspiration and biopsy is an important diagnostic test for patient management. The objective of this study is to find out the incidence various causes of pancytopenia in patients attending to the Enam medical college hospital in savar.
 Materials and Methods: This prospective observational study was done in the department of haematology, Enam Medical College Hospital (EMCH) from July 2012 to June 2019.
 Results: In our study out of 66 patients, 36 (54.55%) were male, 30 (45.45%) were female and male to female ratio were 1.2:1.Generalized weakness 47 (71.21%) and fever 23 (34.85%) were the most common presenting symptoms followed by bleeding 17 (25.76%), weight loss 6 (12.12%), bodyache 6 (9.09%). Most common clinical findings were anemia 57 (86.36%) and bone tenderness 22 (33.33%). Other physical findings were purpura/brusing 13 (19.70%), splenomegaly 10 (15.15%), lymphadenopathy 4 (6.06%) and hepatomegaly 3 (4.55%). Hematological malignancy 29 (43.94%) and hypoplastic marrow 26 (39.39%) were the most common bone marrow finding of pancytopenic patients followed by megaloblastic anaemia 4 (6.06%), leishmaniasias 5 (7.58), and erythroid hyperplasia 2 (3.03%). Acute myeloid leukaemia was the common haematological malignancy 16 (24.24%), others were acute lymphoblastic leukaemia 5 (7.58%). Myelodysplastic syndrome 3 (4.55%), multiple myeloma 4 (6.06%), chronic myelogenous leukaemia in blastic crisis 1 (1.52%).
 Conclusion: So we concluded that complete workup is essential for all cases of pancytopenia to find out the treatable cases and to reduce the motality and morbidity in serious diseases.
 Medicine Today 2020 Vol.32(1): 58-61

Etiological causes of pancytopenia: A report of 137 cases.

Objective:The aim of this study is to evaluate the etiological causes of pancytopenia in patients who were admitted to the hematology ward due to pancytopenia.Materials and Methods:All patients who were admitted to the hematology ward of Ministry of Health Istanbul Training and Research Hospital due to pancytopenia between 2013 and 2015 were retrospectively evaluated regarding etiological causes.Results:A total of 137 patients was evaluated. The etiological causes of pancytopenia were recorded as Vitamin B12 deficiency (n: 24; 17%), chronic liver disease (n: 21; 15%), malignancy (n: 19; 13%), myelodysplastic syndrome (n: 18; 13%), aplastic anemia (n: 11; 8%), rheumatic diseases (n: 7; 5%), and endocrine causes (n: 3; 2%).Conclusion:The etiological causes of pancytopenia vary depends on patients' age, gender, country, and other conditions. Vitamin B12 deficiency is the most common treatable cause of pancytopenia. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imagings, without the need of a bone marrow examination.

Evaluation of bone marrow in cases of pancytopenia in a tertiary care hospital

Background: A spectrum of primary and secondary disorders that affect the bone marrow may manifestwith pancytopenia. This study was carried out to identify the various causes of pancytopenia in patients attending a tertiary care hospital in Lalitpur, Nepal.Materials and Methods: A descriptive study of 83 cases of pancytopenia was carried out in the Department of Pathology, Patan Academy of Health Sciences, Lalitpur, Nepal over a two year period from August 2010 to July 2012.Results: Eighty three patients underwent bone marrow examination. Mean age of the patients was 34 years (range: 4 to 75 years). Maximum number of patients (31.33%) was seen in the age group of 16 - 30 years. The commonest cause of pancytopenia was megaloblastic anemia which was seen in 34.94% (29/83) cases followed by aplastic anemia and hematological malignancies in 31.32% (26/83) and 14.46% (12/83) cases, respectively.Conclusion: This study concluded that megaloblastic anemia and aplastic anemia were the two most common causes of pancytopenia. Bone marrow aspiration is an established diagnostic modality in the evaluation of pancytopenia.Journal of Pathology of Nepal (2015) Vol. 5, 691 - 695

A Case of Acute Myeloid Leukemia Developing after Treatment for Brucellosis with Pancytopenia

Human brucellosis is an important zoonotic disease and has a wide clinical spectrum. Nonspecific hematologic abnormalities related to brucellosis are frequently found, but pancytopenia is uncommon. Malignant diseases have been infrequently reported as a rare cause of pancytopenia in patients with br...

Frequency of causes of pancytopenia in a private hospital in Kathmandu

Background: Pancytopenia is not a disease entity but a triad of findings that result from a number of disease processes. These disorders may affect bone marrow either primarily or secondarily, resulting in the manifestation of pancytopenia. Objective: To identify the various causes of pancytopenia in patients attending to Star hospital, Kathmandu, Nepal. Methods: Fifty two patients with pancytopenia were included in this study from June 2011 to June 2012. Complete blood count, peripheral blood smear, bone marrow aspiration and trephine biopsies were performed according to standard methods. Results: Out of 52 cases, there were 26 cases(50%) of aplastic anaemia, 18 cases(34.61%) of megaloblastic anaemia, 4 cases(7.69%) of acute leukemia, 2cases(3.84%) of erythroid hyperplasia, 1 case(1.92%) of metastatic tumor and 1 case(1.92%) of multiple myeloma. Conclusion: Aplastic anaemia and megaloblastic anaemia were the most common causes of pancytopenia in this study. Health Renaissance, January-April 2013; Vol. 11 No.1; 134-137 DOI: http://dx.doi.org/10.3126/hren.v11i2.8220

Brucellosis presenting with pancytopenia due to hemophagocytic syndrome.

Reactive hemophagocytic syndrome is clinically characterized by fever, hepatosplenomegaly, pancytopenia, and coagulopathy, and is histologically characterized by excessive proliferation and activation of histiocytes or macrophages. It can occur with systemic infections, immunodeficiency, or underlying malignancy. Brucellosis is one of the rare causes of hemophagocytosis. Herein we report an 11-year-old male with pancytopenia due to hemophagocytosis during the course of brucellosis that responded favorably to therapy. Although rare, hemophagocytosis should be considered as a possible cause of pancytopenia in patients with brucellosis, especially in regions where brucellosis is frequently encountered.

A multicenter retrospective study defining the clinical and hematological manifestations of brucellosis and pancytopenia in a large series: Hematological malignancies, the unusual cause of pancytopenia in patients with brucellosis

The aim of the study is to review the clinical manifestations and the hematological findings of brucellosis and pancytopenia, with or without hematological malignancies. The records of 202 patients with brucellosis were evaluated retrospectively. Among these cases of brucellosis seen in a 6 year period between April 1999 and June 2005, 30 patients with pancytopenia were identified. The most common manifestation was fever, followed by weight loss, anorexia, malaise, arthralgia, and hepatosplenomegaly. Bone marrow biopsies revealed hypercellularity or normocellularity. The most common findings in the bone marrow evaluation were histiocytic hemophagocytosis and granulomas. Among all cases, we diagnosed 5 hematological malignancies (1 acute myelogenous leukemia, 2 acute lymphoblastic leukemia, and 2 multiple myeloma) concurrently with brucellosis. The clinical symptoms and findings were similar in patients with and without malignancies. In cases with malignancies, the bone marrow biopsy revealed predominant primary disease involvement. Significant increases in ESR and CRP, severe anemia and thrombocytopenia were observed in patients with malignancies. Peripheral blood counts in patients without malignancies returned to normal after antibiotic treatment for brucellosis. However, pancytopenia in two patients with malignancies did not recover because of primary resistant disease. We conclude that while histiocytic hemophagocytosis may be considered as a major cause of pancytopenia, leukemic infiltration can also be an extreme and unusual cause of pancytopenia in patients in whom brucellosis was concurrently diagnosed with hematological malignancies.

Hemophagocytic syndrome associated with antiepileptic drug

An 8-year-3-month-old male with right porencephaly and epilepsy was found to have skin rash 2 weeks after the beginning of treatment with lamotrigine. One month later he suffered from impaired liver function and pancytopenia in the presence of hypocellular bone marrow with hemophagocytosis. No evidence of infection was evident. Intravenous immunoglobulin and steroid were administered with discontinuation of lamotrigine; the hemogram and liver function profile improved dramatically. Hemophagocytic syndrome should be considered a possible cause of pancytopenia in patients taking new antiepileptic drugs such as lamotrigine.

Hemophagocytic syndrome associated with antiepileptic drug

<h2>Abstract</h2> An 8-year-3-month-old male with right porencephaly and epilepsy was found to have skin rash 2 weeks after the beginning of treatment with lamotrigine. One month later he suffered from impaired liver function and pancytopenia in the presence of hypocellular bone marrow with hemophagocytosis. No evidence of infection was evident. Intravenous immunoglobulin and steroid were administered with discontinuation of lamotrigine; the hemogram and liver function profile improved dramatically. Hemophagocytic syndrome should be considered a possible cause of pancytopenia in patients taking new antiepileptic drugs such as lamotrigine.

Clinico-hematological study of pancytopenia

Background: Pancytopenia refers to a reduction in all the three cellular elements of blood. The aim of this study was to identify the various causes of pancytopenia in patients attending to Manipal teaching hospital in Pokhara. Materials and Methods: This was a cross-sectional study, carried out in Manipal teaching hospital from August 2008 to August 2010. Fifty-four patients with pancytopenia were included in the study. Complete blood count, bone marrow aspirations and trephine biopsies were performed. Data were analyzed using SPSS 11.0 version. Results: Out of 54 cases, there were 16 cases (29.60%) of hypoplastic bone marrow, 15 cases (27.78%) of hematological malignancies, 13 cases (24.10%) of megaloblastic anemia, 4 cases (11.11%) of erythroid hyperplasia and 6 cases (7.41%) of normcellular bone marrow. Acute myeloid leukemia was the commonest hematological malignancy. Conclusion: The commonest cause of pancytopenia in our study was hypoplastic bone marrow followed by hematological malignancies and megaloblastic anemia. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6023 JPN 2012; 2(3): 207-210