Clinicohematological study of pancytopenia - A study of 500 cases
Journal Title: Medpulse International Journal of Pathology - Year 2019, Vol 9, Issue 1
Abstract
Background: Pancytopenia can be due to decrease in hematopoietic cell production in the bone marrow e.g. infections, toxins, malignant cell infiltration, suppression or can have normocellular or even hypercellular marrow without any abnormal cells, e.g. ineffective haematopoiesis and dysplasia, maturation arrest of all cell lines and peripheral sequestration of blood cells. Aims and objectives: To elucidate spectrum of clinical manifestation of various causes of pancytopenia. To study utility of peripheral smear examination and bone marrow examination and other diagnostic modalities in patients with pancytopenia. To study the underlying causes of pancytopenia. Methods: This is retrospective study of 500 case during the year 2014 at civil hospital Ahmedabad with inclusion criteria of Patients with age > 10years, Patients diagnosed to have pancytopenia with Hb<13.5 g/dl in males, Hb<11.5 g/dl in females, Leukocyte count <4000/mm3, Platelet count <150,000/mm3. Pregnancy and Patients receiving chemotherapy were not included in this study. Clinical history taken and Investigations like Hb, TC, DC, Platelet count, MCV, MCH, MCHC, Peripheral smear, Reticulocyte count was done. Bone Marrow aspiration and Bone Marrow biopsy was done when absolute indicated. Results: Out of 500 case of pancytopenia Maximum numbers of patients 24.6% were between 21-30 years of age group. Most common cause of pancytopenia was Megaloblastic anemia. The most common presenting symptom (64.2%) of patients with Pancytopenia was Lethargy and 58.4% patients presented with Dyspnea on exertion. 50% of patients with Megaloblastic Anemia had Hb <6 gm/dl and 36.84% had Hb between 6-8 gm/dl. Hb was 6-8gm/dl in 69.56% patients of Hypersplenism and Most patients of infections. Most patients of Acute leukemia had Hb <6 gm/dl in 84% of patients and all patients of Aplastic anemia had Hb< 6 gm/dl. In Megaloblastic anemia most patients had total leukocyte count between 2000-2999/mm3. In Megaloblastic anemia 31.57% of patients presented with platelet count between 20,000-39,000/mm3. Platelet count was between 40,000-59,000/mm3 in 39.13% of patients of Hypersplenism. Bone marrow study was not done in all patients with obvious cause of Pancytopenia like Hypersplenism, various infections, and drugs in our study. Bone Marrow is Hypercellular in 16.8% patients of Megaloblastic Anemia. All patients of Aplastic anemia were mainly presented with Hypoplastic marrow. Conclusion: Megaloblastic Anaemia is the most common cause of Pancytopenia and infections are the second most common cause of pancytopenia. By taking detailed history including past history, drug history, clinical manifestation and physical examination, we can find out the different etiology of pancytopenia. Early diagnostic approach by means of complete haemogram (Hb, TC, Platelet Count, and MCV), Peripheral smear examination, bone marrow examination and other diagnostic modalities, we can reach to specific etiology of pancytopenia and further, we can plan the best modalities of treatment to cure the disease.
Authors and Affiliations
Sejalkumari M Ninama, Alpesh Chavda
Keywords
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- DOI 10.26611/105915
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