Common Cause Of Pancytopenia Research Articles

Detection of Pancytopenia Associated with Clinical Manifestation and Their Final Diagnosis

Background: Pancytopenia is a common hematological parameter detected in Hematology department. It is important to find out the etiology of pancytopenia for the better management of patient. Pancytopenia represents a wide range of age groups and most pancytopenia is purely of bone marrow dysfunction origin. However, other causes such as hypersplenism and SLE are also frequently encountered. Objectives: To differentiate various causes of pancytopenia, to evaluate the hematological parameters in pancytopenic cases, and to analyze clinical manifestations in cases of pancytopenia. Materials and Methods: There were 25 admitted cases of pancytopenia at Affiliated Hospital of Dali University between the calendar year 2013 and 2014. A detail study was done on the basis of age, gender, clinical features, typical laboratory investigations, bone marrow examination, and final diagnosis. Results and Conclusions: Among 25 cases studied, megaloblastic anemia was the common cause of pancytopenia and incidence of megaloblastic anemia was higher in males after 5th decade of life. Pancytopenic cases age was ranging from 15 to 80 years. Fatigue and dizziness were the most common clinical features presented.

English

INTRODUCTION: Pancytopenia is reduction in all the three hematopoietic cell lines as seen in the peripheral blood. As hematopoietic cells are produced in the marrow, its examination forms an important tool in assessing the etiology of pancytopenia. AIMS: The aim of this study was to identify the etiology of pancytopenia using bone marrow examination and to correlate it with iron stores in the marrow. MATERIAL AND METHODS: This retrospective study was carried out over a period of six years in the department of pathology at Kamineni Academy of Medical Sciences and Research Centre from August 2008 to July 2014. In this period, a total of 765 bone marrow examinations were done, out of which 172 (22%) fulfilled the criteria for pancytopenia. Clinical details, complete blood picture and bone marrow aspiration were done in all the cases. In some cases, trephine biopsy was also done. The biochemical investigations of serum B 12, folic acid and the serum iron profile were available in few cases. RESULTS: In the 172 cases studied, the most common etiology for pancytopenia on marrow examination was that of megaloblastic anemia (38.95 %), followed by erythroid hyperplasia (19.18 %) and dimorphic anemia (14.53 %). Trephine biopsies helped in the diagnosis of aplastic anemias. The iron stores were found to be increased in cases of megaloblastic anemias (61.19 %). There were seven patients on antituberculous treatment, four showed megaloblastic anemia and two had hypoplastic marrows. CONCLUSIONS: Megaloblastic anemia was the commonest cause of pancytopenia in our study. The iron stores are usually high in cases of megaloblastic anemia. Patients on antituberculous drugs should be monitored. The biochemical investigations and the marrow examination should always be performed prior to instituting the treatment.

English

BACKGROUND: Pancytopenia is a relatively common hematological entity resulting from a variety of disease processes. The present study is carried out to find out the causes of pancytopenia by bone marrow examination. MATERIALS AND METHODS: Bone marrow examination is carried out in 120 cases of pancytopenia over a period of 3 years. Age of patients ranged from 2 to 75 years with a mean of 32 years. Most of the patients presented with generalized weakness and fever. Commonest physical finding was pallor followed by splenomegaly. Dimorphic anemia was the predominant blood picture. The commonest marrow finding was megaloblastic erythroid hyperplasia. The commonest cause of pancytopenia was megaloblastic anemia (58.3%) followed by aplastic anemia (18.3%). Others include acute leukemia, myelodysplasia, non-Hodgkin's lymphoma and disseminated tuberculosis. CONCLUSION: The present study shows the importance of bone marrow examination in evaluating pancytopenia and the geographical variation in the etiology as megaloblastic anemia is the predominant cause of pancytopenia in Indian subcontinent.

Bone marrow examination in Egyptian patients with bicytopenia/pancytopenia

The incidences of diseases that cause peripheral blood (PB) cytopenias differ between countries according to the prevalent health problems. This study was carried out in order to identify bone marrow findings and underlying disorders in adult Egyptian patients with PB cytopenias (bicytopenia and pancytopenia). The study involved patients newly diagnosed as having PB cytopenias over a period of 1 year. Clinical and hematological parameters of patients were recorded. Bone marrow specimens were examined. Sixty-two pancytopenia and 50 bicytopenia patients were included in the study. The most common cause of pancytopenia was clonal hematopoietic disorders (34 %), hypersplenism (27 %), and aplastic anemia (21 %). The most common cause of bicytopenia was clonal hematopoietic disorders (34 %), ITP (24 %), and hypersplenism (18 %). Lymphoid neoplasms were the most common and account for 57 % of clonal pancytopenia patients and 65 % of clonal bicytopenia patients. Most hypersplenism patients (86 %) had history of hepatitis C viral infection. Our results show that, in Egypt, clonal hematopoietic disorders, hypersplenism due to chronic liver disease, ITP, and aplastic anemia are the common causes of PB cytopenias. In our setting, causes underlying bicytopenia are as important as those of pancytopenia.

PANCYTOPENIA;

Background: Pancytopenia is an important hematological problem encounteredin our day-to-day clinical practice. The aim of our study was to evaluate clinical features andetiological pattern of pancytopenia at tertiary care settings in Abbottabad. Methods: Thisprospective study was conducted at Northern Institue of Medical Sciences (NIMS) and AyubTeaching Hospital Abbottabad from 25th August 2009 to 31st July 2010. A total of 85 patientsfulfilling the criteria of pancytopenia were randomly selected by time-based sampling.Pancytopenia was diagnosed by anemia (hemoglobin ≤ 10.0g/dl), leucopenia (WBC ≤ 4.0×109/L)and thrombocytopenia (platelets ≤ 150×109/L). All data has been entered and analyzed by SPSSversion 10.0. Results: Out of 85 patients, 62(72.94%) were males and 23(27.05%) females withM to F ratio of 2.69:1. The mean age (±SD) of males was 30.20±15.42 years, while that of females35.12±16.31 years (p=0.20). Among clinical features, anemia and generalized weakness werethe commonest (97.64%), followed by shortness of breath (88.23%). Majority 54(63.52%) hadnon-malignant disorders responsible for pancytopenia. Overall, the most common cause ofpancytopenia was aplastic anemia noted in 30(35.29%) cases, followed by megaloblastic anemia15(17.64%) and hypersplenism in 13(15.29%). Conclusions: On conclusion, aplastic anemiawas the most common cause of pancytopenia in our study predominantly affecting young adultmales. It

Pancytopenia: A clinico-hematological study

<b>Background:</b> A review of both Western and Indian literature shows that there are few comprehensive studies on pancytopenia. In India, the causes of pancytopenia are not well defined. This data, if available, would help in planning the diagnostic and therapeutic approach in patients with pancytopenia. <b>Aim:</b> To evaluate the cases of pancytopenia by peripheral smear and/or bone marrow aspiration and/or bone marrow biopsy to find out the etiology, clinical, hematological, and histomorphologic features of pancytopenia. <b>Materials and Methods:</b> Detailed hematological investigations a complete hemogram, peripheral smear examination, bone marrow aspiration, and biopsy examination were done. <b>Results:</b> The most common cause of pancytopenia in our study was megaloblastic anemia (56%), followed by hypoplastic/aplastic anemia (14%), hypersplenism (8%) and post viral illness (6%). <b>Conclusion:</b> Megaloblastic anemia due to vitamin B12/folate deficiency seems to reflect the higher prevalence of pancytopenia in Indian subjects, putting hypoplastic/aplastic anemia in the second position, which is the leading cause for pancytopenia in the Western countries.

A prospective clinico-hematological study in 100 cases of pancytopenia in capital city of India

Context: Pancytopenia is not a disease but a clinico-hematological entity encountered in clinical practice. A prompt intervention is required to avoid complications, which can occur in these patients. The relevant clinical history and complete hematological workup is required to treat patient of pancytopenia. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Aims: To diagnose different conditions producing pancytopenia on the basis of clinical, hematological and bone marrow studies. To estimate the frequency of different diseases producing pancytopenia. Subjects and Methods: The study was conducted in Department of Hematology of our college in capital city of India. A prospective study was carried out among 100 consecutive patients with pancytopenia. Blood samples of the patients were analyzed for red cells, white cells and platelets morphology along with presence and absence of immature cells and abnormal cells. In bone marrow examination, morphology of all cells lineage, cellularity, parasite and abnormal cells were scrutinized. Trephine biopsy was done where ever indicated. Results: The age of patients ranged from 5 to 80 years. 74% of patients in this study were vegetarian. The most common cause of pancytopenia was megaloblastic anemia (66%) followed by aplastic anemia (18%), malaria (6%), kala-azar (4%), acute myeloid leukemia (2%), multiple myeloma (2%), myelodysplastic syndrome (1%), and tuberculosis (1%). Conclusions: The present study concludes that detailed primary hematological investigations along with bone marrow examination in cytopenic patients is helpful for understanding disease process, to diagnose or to rule out the causes of pancytopenia. It is also useful in planning further investigations and management.

The common causes leading to pancytopenia in patients presenting to tertiary care hospital

The objective of this study was to determine the frequency of common causes leading to Pancytopenia in patients presenting to tertiary care hospital at Karachi. A total of 62 patients with the diagnosis of Pancytopenia of more than one week duration were enrolled in the study. All patients underwent a detailed medical history and full physical examination followed by blood sampling for the investigations i.e. complete blood count with peripheral film, erythrocyte sedimentation rate (ESR), Malarial parasites (MP), liver function test, Renal function tests, PT and viral profile (HBsAg, Anti-HCV), Ultrasonography of abdomen. All patients underwent bone marrow aspiration and trephine biopsy for reporting and interpretation. Duration of study was six months, from May 2010 to November 2010. The average age of the patients was 37.76 ± 16.38years. Out of 62 patients, 36 (58%) were male and 26 (42%) were female. Megaloblastic anemia was the commonest cause that was observed in 41.9% cases followed by acute myeloid leukemia 27.4%, aplastic anemia 19.4% and erythroid hyperplasia 11.3%. Conclusion : This study concluded that most common cause of pancytopenia is Megaloblastic anemia, followed by acute myeloid leukemia and aplastic anemia. Bone marrow examination is a single useful investigation which reveals the underlying cause in patients with pancytopenia.

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

Correlation of Bone Marrow Aspirate, Biopsies and Touch Imprint Findings in Pancytopenia

Background: Pancytopenia is the feature of many life threatening conditions. It is described as the deficiency of all three cellular elements of blood resulting in anemia, leucopenia and thrombocytopenia. It is a common hematological entity that we come across in routine practice. A comprehensive clinical, hematological and bone marrow study of patients usually helps in identification of the underlying cause. However in view of a wide array of etiological factors pancytopenia continues to be a challenge. Aspiration of the marrow is an indispensible adjunct to the study of hematopoietic disorders, if performed correctly. It is simple, safe and can be repeated. In case of trephine biopsy the greater value is that it can provide information about the structure of relatively large pieces of marrow. At the same time morphological features of individual cells may be identified by making imprint from the material obtained. Hence the present study was undertaken to evaluate the accuracy of the three components of marrow examination in the diagnosis of hematological disorders presenting with pancytopenia. Methods: A total of 58 patients presenting with pancytopenia on initial workup requiring bone marrow aspirate and biopsy at MS Ramaiah medical college and hospital, Bangalore were studied from October 2009 to September 2011. Smears were made from the bone marrow aspirate (BMA), stained by Leishmann stain and examined. Touch imprints of bone marrow biopsy (BMB) were made and examined before the tissue was put in fixative (10% neutral buffered formalin) and subsequently processed, embedded in paraffin and sections were prepared and examined. Results: Fifty eight patients with hematological diagnosis of pancytopenia were studied during the period October 2009 to September 2011. The sex distribution of pancytopenia showed male preponderance (60%). Most of the patients were in the age group of 21 - 30 years (25%) and least occurrence was seen in patients more than seventy years (3.45%). The commonest cause of pancytopenia was megaloblastic anemia (39.65%), followed by nutritional anemia (24.13%) and Aplastic anemia (12.06%). Eleven patients (18.9%) were diagnosed on bone marrow biopsy. Forty four out of the total fifty eight cases showed a positive correlation. Conclusion: The commonest cause of pancytopenia was megaloblastic anemia. Clinical history and bone marrow examination is critical in arriving at the diagnosis. There was a positive correlation of 75.8% between BMA and BMB. Both the procedures were complimentary to each other and should be performed simultaneously along with imprint smears for complete bone marrow workup and evaluation. doi: http://dx.doi.org/10.4021/jh76w

Pancytopenia-An Evaluation.

Objectives: A prospective study, to establish the underlying pathology and evaluation of patients with pancytopenia. Materials and Methods: A total of 11 cases of pancytopenia were analyzed over a period of One month i.e. from 1 st August to 31 st August-05 at Department of Pathology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka. All patients who presented with pallor, fever, generalized weakness, and diarrhoea were subjected to complete hemogram and were included in the study based upon the laboratory results. Criteria to consider a case to be pancytopenic are hemoglobin <5g/dl, TLC < 4000/cumm, and platelet count < 1, 50,000/cumm. Patients who had undergone blood transfusion and aged more than 65yrs were excluded from the study. A detailed history and clinical examination was carried out in each case and the relevant information was noted in a proforma. Bone marrow aspiration was performed using Salah’s bone marrow aspiration needle from the iliac crest or sternum. A full blood count was done, peripheral smear and reticulocyte count was also performed in each case. Bone marrow smears were stained with Leishman, Giemsa and iron stain wherever necessary. Results: All patients presented with pallor. Other complaints are fever, generalized weakness, cough, and diarrhea in descending order. The youngest patient being 16yrs old and the oldest patient 58yr old. M: F ratio being 7:4 showing the higher prevalence of the disease in male than in female. Majority of the patients fall in the middle class of socioeconomic group. The most common cause of pancytopenia as revealed by bone marrow was Megaloblastic anemia (73%) and Aplastic anemia (27%). Conclusion: Megaloblastic anemia and Aplastic anemia are the common causes of pancytopenia. M: F ratio being 7:4. Majority of the patients fall under the age group of 26-35yrs (54%) and in the middle class of socioeconomic group.

Study of clinical and aetiological profile of 100 patients of pancytopenia at a tertiary care centre in India

Pancytopenia is not a disease but an important clinico-haematological entity encountered in our day-to-day clinical practice with findings that may result from a number of disease processes. A total of 100 patients of pancytopenia admitted in medicine wards of Civil Hospital, Ahmedabad, Gujuarat, India, were studied. The most common cause of pancytopenia was megaloblastic anaemia (45%) followed by infections (20%) and hypersplenism (15%). As compared with other causes, megaloblastic anaemia was statistically significant cause (P < 0.01) of pancytopenia, in our study. The most common clinical presentation of patients with megaloblastic anaemia was lethargy (100%) and pallor (100%). In patients with megaloblastic anaemia, mean haemoglobin (Hb) was 5.6 ± 1.7 g/dl, mean white blood corpuscle (WBC) count was 2735 ± 4152 and mean platelet count was 52 250 ± 24 213. Mean corpuscular volume (MCV) was 101.2 ± 11 in patients of megaloblastic anaemia. Morphology of RBC was marocytic in 95% of patients with megaloblastic anaemia, whereas hypersegmented neutrophils and macrovalocytes were seen in 60–65% patients of megaloblastic anaemia.

Clinicohematologic analysis of pancytopenia: Study in a tertiary care centre

ABSTRACTBackground and aim: A study was carried out to analyze the presentation, to identify the causes and to find out the bone marrow morphology in cases of pancytopenia. Pancytopenia was an indication for bone marrow examination in 48 out of a total of 100 cases (48%) for which a bone marrow examination was requested. Methods: The data regarding the various signs and symptoms, the causes and the bone marrow findings were obtained and analyzed using simple statistical methods. All age groups were included for the study. Results: Generalized weakness (70.83%) was the commonest symptom and pallor (45.83%) was the predominant sign. Anisocytosis (79.1%) was the most important peripheral blood finding in pancytopenic patients followed by microcytosis (52.08%). The commonest cause of pancytopenia in the present study was hypoplastic marrow (33.33%), followed by normoblastic erythroid hyperplasia (27.08%), megaloblastic marrow (18.75%), and myelodysplastic syndrome (8.33%). Normal bone marrow and dry tap accounted for three cases each (6.25%). Of the various cases of myelodysplastic syndrome, one was refractory anemia; two were refractory cytopenia with multilineage dysplasia and one myelodysplastic syndrome unclassified. Dry tap was seen in three cases of pancytopenia. Bone marrow biopsy was done in one, which showed features of myelofibrosis. Conclusions: A thorough evaluation of the pancytopenic patients is necessary as it has varied causes.

AETIOLOGY OF PANCYTOPENIA

Background: Pancytopenia is a reduction in the number of each type of peripheral blood cell. Therefore the role of bone marrow examintion in diagnosis of pancytopenia is important to know etiology of pancytopenia. The objective of the study was to know the aetiology of pancytopenia. Methods: This descriptive (Cross sectional) study was carried out in Khyber teaching hospital. Fifty patients with pancytopenia were included in the study from 1st January 2008 to 30th October 2008. Full blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. Statistical packages for social science (SPSS.11) was used to analyze data. Results: Out of 50 patients, 36% were of aplastic anaemia, 16% megaloblastic anaemia, 14% myelodysplastic syndrome and 12% acute lymphoblastic leukemia (ALL), Hypersplenism in 10%, 4% non Hodgkin lymphoma (NHL) and 4% multiple myeloma, 2% each of acute myeloblastic leukemia and chronic myelocytic leukemia. All of these disorders were common in male as compared to female. Conclusions: Aplastic anaemia was the commonest cause of pancytopenia followed by megaloblastic anemia and myelodysplastic syndrome in our study.

A study of clinico-haematological profiles of pancytopenia in children

We report on the clinico-haematological profile of pancytopenia in children from the Departments of Pediatrics and Pathology, Institute of Medical Sciences, Banaras Hindu University, India, over a period of 30 months. Pancytopenia was defined as: haemoglobin <10 g/dL, absolute neutrophil count 1.5 x 10(9)/L and platelet count <100 x 10(9)/L. A detailed history, clinical examination and haematological parameters were recorded. Bone marrow aspiration and trephine biopsy were carried out in all cases. One hundred and five cases aged 1.5-18 years, with a mean age of 8.6 years, were included in the study. Aplastic anaemia was the most common cause of pancytopenia (43%) followed by acute leukaemia (25%). Infections were the third most common cause of pancytopenia of which kala azar was the most common. Megaloblastic anaemia was seen in 6.7%.

Pancytopenia in Zimbabwe.

There has been little systematic study of the clinical spectrum of pancytopenia, and the optimal diagnostic approach to pancytopenia remains undefined. The authors studied 134 hospitalized pancytopenic patients in Zimbabwe in both consecutive and nonconsecutive fashion. The most common cause of pancytopenia was megaloblastic anemia, followed by aplastic anemia, acute leukemia, acquired immunodeficiency syndrome (AIDS), and hypersplenism. Severe pancytopenia was usually due to aplastic anemia. Patients with aplastic anemia and acute leukemia were usually children, whereas those with megaloblastic anemia were adults. Moderate to severe anemia was noted throughout the series, but was most striking in patients with megaloblastic anemia, aplastic anemia, and acute leukemia. The mean corpuscular volume (MCV) was elevated in most patients with megaloblastic hematopoiesis, aplastic anemia, and acute nonlymphocytic leukemia. Normal or low MCV values were noted in almost one third of patients with megaloblastic anemia. Anisocytosis, poikilocytosis, macroovalocytosis, microcytosis, fragmentation, and teardrop erythrocytes were more prominent on the blood films of patients with megaloblastic anemia. Megaloblastic anemia, aplastic anemia, and AIDS are the most common causes of pancytopenia in Zimbabwe. Aplasia is the most frequent cause of severe pancytopenia. The authors have formulated tentative guidelines for the evaluation of pancytopenic patients in this setting.

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