Common Cause Of Pancytopenia Research Articles

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.

Clinical and etiopathological profile of pancytopenia in children (1-18 years): A study from tertiary care center of Bundelkhand region, central India

Background: Pancytopenia is defined by a decrease in all three blood components, that is, leukopenia, thrombocytopenia, and anemia below the normal range. This study is an attempt to fill the lacunae regarding the information about pancytopenia in pediatric patients in the Bundelkhand region. The study aimed to study the clinical and etiopathological profile of pancytopenia in children (1–18 years) in the tertiary care center of the Bundelkhand region in central India. Materials and Methods: The present study was a hospital-based cross-sectional observational study conducted to learn about the clinical features, demographic and etiopathological profile of pancytopenia in children. The study was performed with 65 patients aged 1–18 years from September 2021 to August 2022 admitted to the Department of Paediatrics, Maharani Laxmi Bai Medical College and Hospital, Jhansi, and fulfilling inclusion criteria. IBM’s Statistical Package for the Social Sciences version 23 was used for the statistical study. Results: Out of 65 patients, a maximum number of cases were in the age group of 1–6 years (55%). Our study revealed male predominance over females with male-to-female ratio of 2.09:1, mostly belonging to rural areas. The most common presenting complaint was easy fatigue in (90%) of patients followed by fever (54%). The most common physical finding was pallor (100%), followed by splenomegaly and pedal edema (38%) and (18%), respectively. Bone marrow cellularity shows hypocellular marrow (62%), hypercellular (31%), and normocellular (7%). Peripheral smears of most of the patients showed normocytic normochromic (34%), followed by macrocytic hypochromic (30%). Regarding etiology megaloblastic anemia (30%) was reported as the most common cause of pancytopenia followed by malignancies (30%) including myelodysplastic syndrome (9%), multiple myeloma (3%), acute lymphocytic leukemia (9%), and acute myeloid leukemia (9%) followed by aplastic anemia (14%) and sepsis (8%). The study also shows other rare causes of pancytopenia such as disseminated tuberculosis (6%), malaria (9%), and dengue (3%). Conclusion: In the present study, the most common etiologies of pancytopenia come out as nutritional causes, that is, megaloblastic anemia followed by malignancies then aplastic anemia.

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

ETIOLOGICAL PROFILE OF PANCYTOPENIA

Objective: The objective of the study was to describe the etiological profile of pancytopenia. Methods: This was an observational study done in 85 patients who presented with pancytopenia to the Department of General Medicine, Government Medical College, Kottayam. The study was carried out over a period of 1 year. The data were collected in a structured pro forma and analyzed using SPSS version 24. Results: The most common age group was 21–30 years, 29 (34.1%) of the 85 patients. 48 (56.5%) were males and 37 (43.5%) were females. Megaloblastic anemia was the most common etiology constituting 60 (70.6%). The most common presenting complaint was generalized weakness in 74 (87.1%). The most common clinical finding was pallor 77 (90.6%). The mean hemoglobin level was 6.81±1.51 g/dl, the mean total WBC count was 2768.39±791.2, and the mean platelet count was 0.87±0.43. Macrocytic anemia was the predominant blood picture in cytopenic patients. Hypercellular marrow was the most common marrow finding in 78.1%. Conclusion: Megaloblastic anemia was the most common cause of pancytopenia followed by aplastic anemia in the present study. Clinical alertness and suspicion can assure early diagnosis and treatment.

Clinico-Etiological and Clinico-Haematological Study of Patients with Pancytopenia in Rural Area

Abstract Background Pancytopenia is a manifestation of other underlying conditions, commonly associated with multiple benign and malignant conditions. Any patient presenting with pancytopenia requires a thorough evaluation to identify the underlying aetiology. Aim This current evaluates various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia in adult group. Study also correlates clinico-haematological profile. Method Fifty patients with a hematological diagnosis of pancytopenia were studied during the period August 2020 to August 2022. The study included adult patients of both sexes having the age of 18 years and above. Tests for complete blood count, reticulocyte count, peripheral smear, bone marrow aspiration, and trephine biopsy were done. Results Various etiological factors were identified in which majority were of megaloblastic anaemia (48.9%), followed by mixed nutritional anaemia (22.2%), hypersplenism (13.3%), aplastic anaemia (8.9%), malignant conditions (6.7%), myelodysplastic syndromes (2%), and others (4%) respectively. Megaloblastic anaemia cases observed in the age group of 31–50 years with male preponderance. Hemoglobin, TLC, Platelet count, and Reticulocyte count ranged from 2 g% - 10g%, 500–4000 cells/cumm, 24,000–1.5 lakh cells/cumm, and 0.1% – 2%. MCV was higher than 100 fl in 57.5% of cases. Majority of the patients had macrocytic and dimorphic anaemia. Hypersegmented neutrophils were present in all the patients. Bone marrow of Megaloblastic anaemia was hypercellular. Megaloblastic erythropoiesis with giant meta- myelocytes and band forms were seen. Nutritional anaemia seen in the age group of 51-60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 2.3 g%–7.8 g%, 1000–4000 cells/cumm, 5000–1.4 lakh cells/cumm, and 0.1–8%. Two cases had microcytic hypochromic anaemia in Nutritional anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 93.8% of cases. In hypersplenism seen in the age group of 51–60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.8 g% – 10 g%, 1700–3800 cells/cumm, 26000-1.4 lakh cells/cumm, and 0.6–2% respectilvey in hypersplenism. 40% of hypersplenism patients had microcytic hypochromic anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 70% of hypersplenism cases. Aplastic anaemia seen in the age group of 41–50 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.1–10 g%, 1100–4000 cells/cumm, 51000–1.5lakh cells/cumm, and 0.2%–1.8%. Aplastic anaemia (35.8%) cases showed macrocytosis. Bone marrow was hypocellular with an increase in marrow fat and Lymphocytes and plasma cells were prominent in Aplastic anaemia cases. Leukaemia commonly seen in the age group of 31–40 years with male predominance. Hemoglobin, TLC, and Reticulocyte count ranges from 5.1–9.8%, 1100–4000 cells/cumm, and 0.6–2% respectively. Bone marrow was hypercellular with a reversal of M:E ratio in 80%. Conclusion Megaloblastic anaemia was the commonest cause of pancytopenia. Most other studies have reported aplastic anaemia as the commonest cause. This seems to reflect the higher prevalence of nutritional anaemia in the Indian subjects. The haematological parameters and bone marrow morphological features in patients with megaloblastic anaemia, aplastic anaemia, and malignant diseases including MDS in the present study were comparable to the findings by other authors. Uncommon etiological factors like dengue fever and hemolytic anaemia were identified in this study. A comprehensive clinical, haematological, and bone marrow study of patients with pancytopenia usually helps in identification of the underlying cause. However, in view of a wide array of etiological factors, pancytopenia continues to be a challenge for hematologists.

EVALUATION OF PANCYTOPENIA WITH BONE MARROW INTERPRETATION

Background: Pancytopenia is one of the most common clinico-haematological entity observed in our day to day clinical practice. It is a disorder in which all the three major elements of blood (i.e. red blood cells, white blood cells and platelets) are decreased in number. The causes of pancytopenia may be due to decrease in hematopoietic cell production in the marrow resulting from infections, toxins, malignant cell inltration, post- chemotherapy or post-radiation. Aims and Objectives: 1) To study the etiology and clinical presentation of pancytopenia in all age groups. 2) To correlate with bone marrow interpretation Materials & Methods: This is a prospective study which was conducted among 50 patients of pancytopenia in the Clinical Pathology, Government General Hospital,Kurnool from January 2021 to October 2022 Bone marrow aspiration was done by using Salah's bone marrow puncture needle. Smears were made from bone marrow aspirate (BMA) and stained by Leishman stain and special stains like Perl`s wherever necessary. The smears were assessed for cellularity, differentiation and maturation of erythroid, myeloid and megakaryocytic lineage, M:E ratio, Plasma cells, Lymphocytes and parasites/ abnormal cells. In the present study the commonest cause of Pancytopenia was Megaloblastic anemia (70%) follo Results: wed by Dimorphic anemia (20%). The less common conditions were Multiple Myeloma (6%),Chronic Myeloid Leukemia(2%),Acute Leukemia(2%). The present study concludes that com Interpretation and Conclusion: plete primary hematological investigations along with bone marrow aspiration in pancytopenic patients are helpful for understanding disease process and to diagnose or to the rule out causes of pancytopenia. These are also helpful in planning for further investigations and management.

Clinicoetiological profile of children with bicytopenia and pancytopenia

BackgroundBicytopenia, and pancytopenia have a wide etiological spectrum in children, ranging from viral infections to malignancies. There is limited data describing the clinicoetiological profile of bicytopenia and pancytopenia in children in recent times. MethodologyFifty children, aged 1 month to 12 years admitted with bicytopenia and pancytopenia were enrolled and evaluated. Basic patient information and clinical findings along with relevant investigations were obtained on a predesigned proforma and analyzed statistically. ResultsAmong the 50 cases studied, 46 had non-malignant causes, 24 (92.3%) cases had bicytopenia and 22 (91.66%) had pancytopenia. Among the 46 cases, 20 were infectious in origin. Sepsis was the commonest cause comprising 7 out of 20 cases (35%). Other causes included dengue fever, enteric fever, and malaria. The commonest cause of bicytopenia was nutritional anemia, observed in 8 out of 15 (53%) cases. The common causes of pancytopenia were megaloblastic anemia and aplastic anemia. Hematological parameters were significantly different among the bicytopenic and pancytopenic groups. MCH and MCHC were not significantly different between the groups. Hemoglobin and low white cell count were observed in aplastic anemia while thrombocytopenia was more marked in patients with megaloblastic anemia. A diagnosis of leukemia was made in 4 out of 50 cases, of which 2 each had pancytopenia and bicytopenia at presentation. ConclusionThe common causes of bicytopenia and pancytopenia were infections and nutritional deficiency. A history, examination and basic diagnostic tests were rewarding for the diagnosis in the majority.

Etiological Spectrum of Pancytopenia in Children of Southern Punjab

Background: Pancytopenia is an intermittent hematological finding in children presenting with erratic clinical features like fever, pallor, petechiae, bleeding, distended abdomen, failure to thrive. Aim: To evaluate the pattern of causes responsible for pancytopenia in children of southern Punjab. Study Design: Randomized control trail. Methodology: We enrolled 121 children, aged 1-15 years with pancytopenia after written informed consent for a period of one year in Pathology department of Children’s Hospital-Multan. Cell morphology was studied through microscopy on blood peripheral film and bone marrow aspiration film. The relevant investigations were performed to assess the pattern of causative agents in pediatric population of Southern Punjab, Pakistan. Data was presented as percentage through SPSS v20.0. Results: Fever, pallor and body-aches were the common (80%) clinical presentations in our patients. Mean ± SD age of patients was 7.1± 3.98 years. 56.50% of patients with pancytopenia had hyper-cellular marrow while 43.50% had hypo- cellular marrow. Aplastic anemia and Acute Lymphoblastic Leukemia were the common causes for pancytopenia. Conclusion: We concluded that aplastic anemia and ALL were the most common causes of pancytopenia in Southern Punjab, Pakistan. Infections and other treatable causes were also important causes of thrombocytopenia present in significant number (21.7%) of patients which we can address timely and reverse the serious outcomes. Keywords: Anemia, Bone Marrow, Megaloblastic and Pancytopenia.

Clinical and Etiological Profiles of Patients With Pancytopenia in a Tertiary Care Hospital.

Background Pancytopenia is more of a manifestation of a spectrum of underlying diseases affecting the bone marrow. Specific treatment relies solely on early diagnosis and identification of the accurate etiology. We aimed to generate data on the clinical and etiological profiles of patients diagnosed with pancytopenia. Materials and methods Fifty patients more than 13 years of age with pancytopenia who reported to a tertiary care hospital were included in the study. Thorough clinical examination, hematological investigation, and bone marrow biopsies were performed, and relevant data were recorded and analyzed statistically. Results Pancytopenia was most common in the age group of 25-34 years, with a male preponderance. The most common presenting complaints were fatigue and fever, with pallor present in all patients, followed by splenomegaly and hepatomegaly in a few patients. Aplastic anemia is the most common cause of pancytopenia, followed by megaloblastic anemia and leukemia. Conclusion While fatigue and fever are the most usual symptoms of pancytopenia, clinical pallor, hepatomegaly, and splenomegaly may be evident. Among the several etiologies, aplastic anemia is one of the most common causes of pancytopenia.

BONE MARROW EXAMINATION IN PATIENTS OF CYTOPENIA - A STUDY ON CLINICAL AND ETIOLOGICAL PROFILE

Introduction: Bone marrow examination is an important diagnostic tool and the cornerstone of hematology. Cytopenia is a descriptive term referring to a reduction in any of the three blood cell lineage erythrocytes, leukocytes and platelets. This study aimed toAims And Objectives: determine the clinical and etiological prole in patients of cytopenias undergone bone marrow examination. it was aMaterial And Methods: prospective observational hospital based study conducted over a period of 18 months (July 2016 to January 2018) in the department of Pathology, Krishna Institute of Medical Science, Secunderabad. Complete history, physical examination, complete blood count, peripheral blood lm and bone marrow aspiration was done in 400 patients who presented with cytopenias. Out of 400 patients, 208 cases were male and 192 wereResults: females with Male: female ratio 1.08:1. Age ranging from 1 to 87 years with mean age of patient's was 43.5 years. Out of 400 patients of cytopenia 167 cases were neoplastic and 226 cases were non-neoplastic while 7 cases showed normal marrow ndings. Findings in these cases included megaloblastic anemia, acute leukemia, immune thrombocytopenic purpura, and plasma cell myeloma as the commonest cause of pancytopenia, bicytopeia, thrombocytopenia and anemia respectively. Bone marrow evaluation is an important and effective tool in diagnosing andConclusion: evaluating hematological disorders.

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.

Spectrum of Pancytopenia in Adults Attending a Clinical Hematology Department: A Four-Year Experience From a Tertiary Care Center of Western India.

BackgroundPancytopenia is a common hematological condition encountered in clinical practice. Because there is a wide variation in causes of pancytopenia even in different populations of the same geographical region, identifying the pattern of underlying etiologies is crucial for proper management. This study was conducted to evaluate the clinico-hematological profile and different etiologies of pancytopenia among adults presenting to a clinical hematology department at a tertiary care hospital of Western India.MethodologyThis observational study was conducted over a period of four years on 546 adult patients aged 18-93 years presenting with pancytopenia. After obtaining a detailed clinical history and physical examination, all participants were subjected to relevant investigations including bone marrow examination.ResultsA slight male preponderance was observed, and the most common age group (24%) was 21-30 years. Pallor was the most common clinical feature, followed by generalized weakness and fever. The most common cause of pancytopenia was acute leukemia (17.9%), followed by megaloblastic anemia (15.4%), aplastic anemia (11.0%), hypersplenism (7.8%), multiple myeloma (6.6%), and myelodysplastic syndrome (5.3%).ConclusionsAcute leukemia was observed to be the most common cause of pancytopenia in this study, which is in contrast to various other studies from India conducted in different departments. Identification of etiologies of pancytopenia among patients attending hematology departments in various regions is expected to be useful in formulating diagnostic algorithms and management strategies, which can help clinicians to better manage such patients.

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

Clinical, etiological and hematological profile of pancytopenic childern admitted in balchikitsalaya of RNT medical college, Udaipur Rajasthan

To study the Clinical, Etiological and Hematological profile of Pancytopenic Children age group from 1 month to 18 years admitted in BalChikitsalay of MBGH, RNT Medical college, Udaipur. A Hospital based prospective study on children age group from 1month to 18 years admitted having pancytopenia and consenting for study were enrolled in study. Children who had received blood transfusion in previous 3 months, not consenting for study and known case of acute leukemia, aplastic anemia were excluded from study. Study was conducted in Balchikitsalay, MBGH, RNT Medical college, Udaipur, Rajasthan for a period of 1 year. 42 children were enrolled in this study among this 22 were male and 20 were female. Most of the children presented with pallor (100%) fever (88%), bleeding manifestations (78.5%), pain abdomen (35.7%). On examination all these were anemic (100%), had splenomegaly(64.2%) ,hepatomegaly(59.5%) and bleeding manifestation in the form of hematemesis(21.4%) ,petechiae(26.1%) ,bleeding gums(21.4%) . Hematological findings in majority of children were anemia 4 to 7mg/dl, WBC count 2000to 4000/mm and Platelet count20,000 to 50,000/mm. Peripheral Blood smear revealed blast cells in 11patients, megaloblasts in 8 patients and malarial parasite in 3 children. Serum Vitamin B12 levels were <200 pg/ml in 20 children and <100 pg/ml in12 children. Bone marrow examination was performed in 36 children which revealed hypercellular marrow (28),normocellular marrow (5), hypocellular marrow(3). Most common cause of pancytopenia was vitamin B12 deficiency (40.4%). Other common causes were ALL (21.4%), Aplastic anemia (7.1%), Scrub typhus (7.1%), falciparum malaria (7.1%), CLD (7.1%), AML two patient Dengue & SLE one patient each. Vitamin B 12 deficiency is the commonest cause of pancytopenia, followed by ALL (21.4%) & Aplastic anemia (7.1%).

Aetiological Profiles of Pancytopenia in Children between 2 months to 12 years of AgeA Retrospective Study from a Tertiary Care Centre, Chennai, India

Introduction: Pancytopenia is a medical condition that generally exists among children in which the peripheral blood cell lineages are found to reduce in blood. The condition is diagnosed as a common haematological problem with an extensive differential diagnosis and vary according to the geographical distribution and genetic mutation. The condition is reversible and easily treatable if identified at the earliest. Aim: To determine the frequency of aetiological spectrum of pancytopenia in children between the age of 2 months to 12 years from Chennai, Tamil Nadu, India. Materials and Methods: A retrospective descriptive study was carried out at the Institute of Child Health, Madras Medical College, Chennai, Tamil Nadu, India, from January 2016 to December 2016. Out of 12,869 patients admitted, 91 children were identified with pancytopenia based on peripheral blood smear analysis. Complete blood count, peripheral smear, red blood cell indices, bone marrow examination, and serum vitamin B12 levels were analysed. The complete data was tabulated in Microsoft excel sheet and frequency(n) and percentage (%) analysis was performed. Results: Total of 91 children of pancytopenia (45 males and 46 females , aged from 6 months to 12 years) were included in the study and analysed. Majority of the pancytopenia children belonged to the age group of 1 to 6 years (40, 43.9%). The identified common clinical presentations for admission include the unexplained fever (82.92%), pallor (10.8%), and bleeding (9.79%). The common major aetiologies were megaloblastic anaemia (23, 25.2%), acute lymphoblastic leukaemia (17, 18.6%), and aplastic anaemia (12, 13.1%). Infections due to microorganisms in children also cause pancytopenia and there was one child each with the infectious symptoms due to Human Immunodeficiency Virus (HIV), tuberculosis, and Epstein-Barr Virus (HBV). Conclusion: Acute leukaemia and bone marrow failure were identified as the most common causes of pancytopenia in children. It is highly advisable to record the symptoms related with iron deficiency anaemia along with the symptomatic issues of certain viral and bacterial infections among children from the developing nations while diagnosing pancytopenia.

English

BACKGROUND This is a clinic-haematological study, conducted in Sidhanta Hospital, Bhopal, to identify the causes of pancytopenia. Out of total 1200 cases of complete hemograms, 56 cases were categorized as pancytopenias, and out of these, 24 cases were subjected to bone marrow examination. The remaining 32 cases of pancytopenia, were put on periodic follow up with peripheral blood smear examination, based on clinical data. Pancytopenia is the simultaneous presence of anaemia, leucopenia and thrombocytopenia that may result from various disease processes, involving the bone marrow primarily or secondarily. Pancytopenia is reduction in all the three cellular components of the blood, namely red blood cells (RBCs), leucocytes (WBCs) and platelets. It is a common entity which is encountered by practitioners. The presentation is in the form of cytopenias leading to infections, anaemia, or bleeding manifestations. All the cases of pancytopenia need a through approach to reach to the cause of the same so that it can be managed in the best possible manner. Cytopenias are reduction in any of the three cellular components of the blood i.e. RBCs, WBCs or platelets. It can be reduction in two cellular components (bicytopenia) or a reduction in all the three cellular components (pancytopenia). In bicytopenia, the most common combination to be seen is anaemia and thrombocytopenia, whereas the least common is leucopenia with thrombocytopenia. (1) For practical purposes, it should have haemoglobin < 10 g%, absolute neutrophil count < 1,500/cumm and platelets < 1,00,000/cumm. It is labelled as severe when the three values are < 7 g%, < 500/cumm and < 20,000/cumm respectively. The purpose of this study was to find out different causes of pancytopenia and the use of bone marrow examination in evaluation of pancytopenia. METHODS This is a cross sectional study, conducted exclusively in the Department of Medicine, at a tertiary care hospital, in Bhopal from August 2019 to December 2019. A total of 56 cases of pancytopenia were analysed with clinico-haematological features. Criteria for diagnosis of pancytopenia were: Haemoglobin less than 10 gm/dl, TLC less than 4000/mm3 and platelet count less than 1,00,000/mm3. We have correlated the complete hemogram findings with bone marrow examination (if required) and peripheral smear examination in order to analyse the root cause of every case of pancytopenia. Pancytopenia is a haematological entity, we have to analyse the cause of it in order to find out the correct diagnosis and treat the patient accordingly. Bone marrow examination is useful in the investigation of PUO (pyrexia of unknown origin), as it leads to an etiological diagnosis in many of the cases. RESULTS In these 56 cases, only 24 cases (42.85 %) were subjected for bone marrow examination. Commonest cause of pancytopenia was episode of viral fever constituting 28 cases (50 %). CONCLUSIONS In cases of PUO, bone marrow examination is a very useful investigation. In cases diagnosed as idiopathic thrombocytopenic purpura (ITP), when the patient does not show improvement in counts, a repeat bone marrow examination should be done, as very rarely; acquired amegakaryocytic thrombocytopenia may be the cause. Though bone marrow examination is an absolute indication in cases of pancytopenia, it is important to wait for at least 2 – 3 weeks, and do a repeat hemogram, especially in cases of viral fever where the counts usually improve after fever subsides. KEY WORDS Pancytopenia, Bone Marrow, Viral Fever

EVALUATION OF PANCYTOPENIA IN ADULTS PATIENTS OF BIHAR

INTRODUCTION– Pancytopenia usually indicates presence of serious underlying disease. Determining the etiology of pancytopenia is important for appropriate management of the patients. AIMS AND OBJECTIVES- This study was undertaken to identify the etiological factors leading to pancytopenia in a tertiary care hospital of Bihar. MATERIAL AND METHODS– This was a prospective study conducted over 12 months in the department of pathology, Nalanda medical college, Patna. The study included adult patients (>18yrs) who had pancytopenia in complete blood count. Relevant blood tests and bone marrow aspiration (BMA) and bone marrow biopsy (BMB) were done to delineate the etiology of pancytopenia. RESULTS– The commonest cause of pancytopenia in our study was aplastic anemia (46.67%) followed by megaloblastic anemia (23.33%) and hematological malignancies (acute leukemia and lymphoma- 15%). Other causes include infective diseases (kala-azar, malaria and tuberculosis), hypersplenism and hemophagocytosis. CONCLUSION- Determination of etiology of pancytopenia needs detailed clinical history and physical examination, and appropriate hematological tests and bone marrow examination.

Clinico-hematological profile of pancytopenic adult patients in a tertiary care teaching hospital.

Objective:The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital.Materials and Methods:The study was conducted on 100 adult patients aged 18–65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the Chi-square test. A P =0.05 was considered statistically significant.Results:A female preponderance was observed, and the majority of patients were aged between 18 and 40 years. The most common clinical features were generalized weakness, fever, and pallor. Seventy-four percent of patients were vegetarians; 58% had vitamin B12 deficiency, 25% had folic acid deficiency and 19% had a deficiency of both. The most common cause of pancytopenia was megaloblastic anemia (MA) (37%), followed by dimorphic anemia (DA) (26%), aplastic anemia (AA) (20%), and hematological malignancies (11%).Conclusion:MA, DA, and AA are the most prevalent etiologies of pancytopenia. BM examination is of utmost importance in the definitive diagnosis of pancytopenia and is useful in initiating timely treatment as a significant number of causes of pancytopenia are potentially curable.