Diagnostic Approach of New-Onset Pancytopenia: Study from A Tertiary Care Center

Pancytopenia 2 Years Retrospective Study

  • Vijay Kumar Associate Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
  • Manika Khare Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
  • Manjari Kishore Senior Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
  • Megha Sharma Resident, Dept. of Pathology, PGIMER, Dr. RML Hospital, New Delhi.
  • Sadhna Marwah Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
  • A.S. Nigam Consultant Pathologist, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi
  • Pratap Singh Associate Professor, Dept of Medicine, PGIMER, Dr. RML Hospital, New Delhi
DOI: https://doi.org/10.21276/apalm.1875
Keywords: Pancytopenia, bone marrow, leukemia, infection

Abstract

Background: Pancytopenia is a disorder associated with decrease in number of all three major formed elements of blood (red blood cells, white blood cells and platelets). It is a triad of findings resulting from many disease processes. This may be associated with various hematopoietic and non-hematopoietic condition involving the bone marrow. The management and prognosis of patients with pancytopenia is based on the severity of pancytopenia and the underlying disease process. The present study helps in highlighting the role of various laboratory parameters in conjunction with clinical findings in evaluation of these patients.   Methods: The present retrospective study was done for 2 years from April 2015 to April 2017 in Department of Pathology. A total of 210 patients with pancytopenia were included in the study. A detailed history and hematological findings including the bone marrow findings and flow cytometric results were noted in these patients, wherever available. Result: Out of 210 patients, 136 were adults and 74 were children. The mean age of the patients was 42 years. The male to female ratio was 2.7:1. The most common clinical feature in our study was pallor (in all cases) followed by fatigue (70.9%). Most of the cases had severe anemia (57.8%). Megaloblastic anemia was found to be the most common cause, constituting 61.9% of all cases, followed by hypersplenism (25.7%), aplastic anemia (9%), leukemia (1.9%). Occasional cases of kala-azar, typhoid and malaria was also noted. Conclusion: A proper clinico-hematological examination aids in making a proper diagnosis in patient presenting with pancytopenia. Sometimes, specific clinical features point towards a certain disease process. Various laboratory parameters can help in diagnosing the underlying disorder leading to pancytopenia. This diagnostic approach will facilitate to highlight the significance of various diagnostic modalities.

Author Biographies

Vijay Kumar, Associate Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Associate Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Manika Khare, Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Manjari Kishore, Senior Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Senior Resident, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Megha Sharma, Resident, Dept. of Pathology, PGIMER, Dr. RML Hospital, New Delhi.
Resident, Dept. of Pathology, PGIMER, Dr. RML Hospital, New Delhi.
Sadhna Marwah, Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
Professor, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi.
A.S. Nigam, Consultant Pathologist, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi
Consultant Pathologist, Dept of Pathology, PGIMER, Dr RML Hospital, New Delhi
Pratap Singh, Associate Professor, Dept of Medicine, PGIMER, Dr. RML Hospital, New Delhi
Associate Professor, Dept of Medicine, PGIMER, Dr. RML Hospital, New Delhi

References

1. Keisu M, Osta A. Diagnosis in patients with severe pancytopenia suspected of having aplastic anemia. Eur J Haematol 1990; 45:11-4.
2. Gayathri BN, Rao KS. Pancytopenia: A clinico hematological study. J Lab Physicians 2011;3:15-20.
3. International agranulocytosis and aplastic anemia study. Incidence of aplastic anemia: The relevance of diagnostic criteria. Blood 1987;70:1718-21.
4. Kumar R, Kalra SP, Kumar H, Anand AC, Madan H: Pancytopenia – a six year study. J Assoc Physicians India 2001, 49:1078–1081.
5. Iqbal W, Hassan K, Ikram N, Nur S: Aetiological breakup of 208 cases of pancytopenia. J Rawal Med Coll 2001, 5:7–10.
6. Savage DG, Allen RH, Gangaidzo IT, et al. Pancytopenia in Zimbabwe. Am J Med Sci 1999; 317:22-32.
7. Khunger JM, Arculselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia-A Clinico-hematological study of 200 cases. Indian J PatholMicrobiol 2002;45:375-9.
8. Knodke K, Marwah S, Buxi G, Vadav RB, Chaturvedi NK. Bone marrow examination in cases of pancytopenia. J Academy Clin Med 2001;2:55-9.
9. Santra G, Das BK: A cross-sectional study of the clinical profile and aetiological
spectrum of pancytopenia in a tertiary care centre. Singapore Med J 2010, 51:806-812
10. Malik AS. Complications of bacteriologically confirmed typhoid fever in children. J Trop Pediatr 2002; 48:102-8
11. Arya TV, Prasad RN. Fatal pancytopenia in falciparum malaria. J Assoc Physicians India 1989; 37:469-70.
12. Ohno T, Shirasaka A, Sugiyama T, Furukawa H. Hemophagocytic syndrome induced by Plasmodium falciparum malaria infection. Int J Hematol 1996; 64:263-6.
13. Aouba A, Noguera ME, Clauvel JP, Quint L. Haemophagocytic syndrome associated with plasmodium vivax infection. Br J Haematol 2000; 108:832-3.
14. Zvulunov A, Tamary H, Gal N. Pancytopenia resulting from hemophagocytosis in malaria. Pediatr Infect Dis J 2002; 21:1086-7.
15. Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta AK. Pancytopenia in children: Etiological profile. J Trop Pediatr 2005;51:236-9
16. Gupta V, Tripathi S, Tilak V, Bhatia BD. A study of clinico-haematological profiles of pancytopenia in children. Trop Doct 2008;38:241-3
17. Tilak V, Jain R. Pancytopenia- a clinico-hematological analysis of 77 cases. Indian J Pathol Microbiol 1999;42:399-404.
Published
2018-08-19
Issue
Vol 5 No 8 (2018)
Section
Original Article

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