Etiological Evaluation of Pancytopenia in a Tertiary Care Hospital
Keywords:
Pancytopenia, Hypersplenism, Malaria, Alcohol liver disease.
Abstract
Background: Pancytopenia is not a disease by itself, however it is a common hematological problem characterized by simultaneous presence of anemia, leucopenia and thrombocytopenia. The disease pattern associated with pancytopenia varies with geographic location, age group, nutritional status, drug intake and prevalence of infective disorder.This prospective study was to investigate and identify different causes of pancytopenia with frequency, to ascertain percentage of occurrence of pancytopenia, to determine its incidence in relation to sex and age, and to compare findings with those of other similar studies.Methods: 80 patients diagnosed with pancytopenia were clinically evaluated, with complete blood count, peripheral smears, and bone marrow aspiration-biopsy whenever possible in Justice K. S. Hegde Hospital attached to Nitte University, Deralakatte, Mangalore, from June 2012 to June 2014.Results: Among the 80 cases analyzed, most of the cases were seen in the age group of 41-50 years, with male predominance. Hypersplenism (28.75%), malaria (16.25%) and megaloblastic anemia (13.75%) were the three commonest causes in our hospital. In 13 cases of malaria, Plasmodium vivax (8 cases) was most commonly noted.Conclusion: The present study concludes that varied causes of pancytopenia can be attributed to the geographic area, nutritional and drug intakes, personal habits, infective causes, stringency of diagnostic criteria, and differences in methodology used. Hence, a detailed clinical history and meticulous examination along with hematological investigations provide invaluable information in the complete workup of patients with pancytopenia for understanding the disease processes, planning further investigations and management, and ascertain the cause.References
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30) Ballard HS. The hematological complications of alcoholism. Alcohol health and research world 1997;21:42-52.
31) CF Weston and MJ Hall. Pancytopenia and folate deficiency in alcoholics. Postgrad Med J 1987;63:117–120.
32) Aziz T, Ali L, Ansari T, Liaquat HB, Shah S, Ara J. Pancytopenia: Megaloblastic anemia is still the commonest cause. Pak J Med Sci 2010;26:132-6.
33) Ganti AK, Shonka NA, Haire WD. Pancytopenia due to iron deficiency worsened by iron infusion: a case report. J Med Case Reports. 2007;1:1.
34) Weinzierl EP, Arber DA. The Differential Diagnosis and Bone Marrow Evaluation of New-Onset Pancytopenia. Am J Clin Pathol 2013;139:9-29.
35) Bailey FA, Lilly M, Bertoli LF, Ball GV. An antibody that inhibits in vitro bone marrow proliferation in a patient with systemic lupus erythematosus and aplastic anemia. Arthritis Rheum 1989;32:901-5.
36) Roffe C, Cahill MR, Samanta A, et al: Aplastic anaemia in systemic lupus erythematosus: A cellular immune mechanism? Br J Rheumatol 1991;30:301.
37) Sumimoto S, Kawai M, Kasajima Y, Hamamoto T. Aplastic anemia associated with systemic lupus erythematosus. Am J Hematol 199;38:329-31.
38) Abrams EM, Gibson IW, Blydt-Hansen TD: The concurrent presentation of minimal change nephrotic syndrome and aplastic anemia. Pediatr Nephrol 2009;24:407.
39) Kritharis A, Bastola S, Zhang X, Scott Z. Idiopathic Autoimmune Pancytopenia Treated With Rituximab. Available at: http://www.northshorelij.com/ccurl/341/39/Kritharis.pdf
40) Tariq M, Khan NU, Basri R, Said A. Aetiology of pancytopenia. Professional Med J 2012;17:252-6.
2) Niazi M, Raziq F: The incidence of underlying pathology in pancytopenia – an experience of 89 cases. J Postgrad Med Inst. 2004; 18:76–79.
3) Thakkar BB, Bhavsar UN, Trivedi NJ, Agnihotri AS. A study of pancytopenia in adult patients more than 12 years of age in North West region of saurashtra. Nat J Med Res. 2013;3:48-52.
4) Jalbani A, Ansari IA, Shah AH, Gurbakhshani KM, Chutto M, Solangi GA. Pancytopenia; Study of 40 patients at CMC Hospital Larkana. Professional Med J. 2010;17:105-10.
5) Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia-largest series reported to date from a single tertiary care teaching hospital. BMC Hematology. 2013;13:1-9.
6) Tilak V, Jain R. Pancytopenia- A clinic-hematologic analysis of 77 cases. Indian J Pathol Microbiol. 1999;42:399-404.
7) Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia- A clinicohaematological study of 200 cases. Indian J Pathol Microbiol. 2002;45:375-9.
8) Kumar DB, Raghupathi AR. Clinicohematologic analysis of pancytopenia: Study in a tertiary care centre. Basic and Applied Pathology. 2012;5:19-21.
9) Gayathri BN, Rao KS. Pancytopenia: a clinico hematological study. J Lab Physicians. 2011;3:15-20.
10) Hamid GA, Shukry SA. Patterns of pancytopenia in Yemen. Turk J Hematol. 2008;25:71-4.
11) Asharaf S, Naeem S: Frequency of hypersplenism in chronic liver disease patients with pancytopenia. Annals of King Edward Medical University, North America, Special Edition Annals 2010, 16(1):108–110.
12) Latger Cannard V, Bibes B, Dao A, et al. Malaria related cytopenia. Ann Biol Clin. 2002;60:213-216.
13) Aouba A, Noguera ME, Clauvel JP, Quint L. Haemophagocytic syndrome associated with plasmodium vivax infection. Br J Haematol. 2000; 108: 832-833.
14) 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;51:806-12.
15) Malaria in India – Malaria site. Alvailable at: http://www.malariasite.com/malaria-india/
16) Tareen SM, Tariq MM, Bajwa MA, Awan MA, Ahmad Z, Javed Y. Study of pancytopenia in Balochistan, Pakistan. Gomal Journal of Medical Sciences 2012;10(2).
17) Arya TV, Prasad RN. Fatal pancytopenia in falciparum malaria. J Assoc Physicians India. 1989;37:469-70.
18) Hemmer R. Airport malaria in Luxembourg. Euro Surveillance Weekly. 1999;3:790-819.
19) Malaria in Mangalore – Malaria site. Available at: http://www.malariasite.com/category/epidemiology/
20) Savage DG, Allen RH, Gangaidzo IT, Levy LM, Gwanzura C, Moyo A et al. Pancytopenia in Zimbabwe. Am J Med Sci. 1999;317:22-32.
21) Devi PM, L Rajesh Singh, Sharma PS, Singh AM, Singh MK, Singh YM. Clinico-hematological Profile of Pancytopenia in Manipur, India. Kuwait Med J 2008;40:221-4.
22) Weinzierl EP, Arber DA. Bone marrow evaluation in new-onset pancytopenia. Human pathology. 2013;44:1154-64.
23) M Montalto, I Porto, A Gallo, C Camaioni, RD Bona, A Grieco et al. Clopidogrel-Induced Neutropenia after Coronary Stenting: Is Cilostazol a Good Alternative? International Journal of Vascular Medicine. 2011;2011.
24) Uz O, Kardesoglu E, Aparci M, Yiginer O, Isilak Z, Ozmen N. Nonfatal aplastic anemia associated with clopidogrel/Klopidogrel ile iliskili olumcul olmayan aplastik anemi. The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi). 2010;10:291-2.
25) Chan J, Sanders DC, Du L, Pillans PI. Leflunomide-associated pancytopenia with or without methotrexate. Ann Pharmacother 2004;38:1206-11.
26) EC Gordon Smith. Aplastic anemia and pure red cell aplasia. In: Anna Porwit, Jeffrey McCullough, Wendy N. Erber, editors. Text Book of Blood and Bone Marrow Pathology, 2nd ed. Britain: Churchill Livingstone Elsevier; 2011. 213-24.
27) Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone marrow examination in cases of pancytopenia. J Indian Acad Clin Med 2001;2:55-9.
28) Angela Dispenzieri, Martha Q. Lacy, Philip R. Greipp. Multiple Myeloma. . In: Jonathan W. Pine, editor. Text Book of Wintrobe’s Clinical Hematology, 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. 2372-438.
29) Plasma cells neoplasms. In: Barbara J Bain, David M Clark, Bridget S Wilkins, editors. Text Book of Bone Marrow Pathology, 4th ed. UK: Wiley-Blackwell; 2010. 421-60.
30) Ballard HS. The hematological complications of alcoholism. Alcohol health and research world 1997;21:42-52.
31) CF Weston and MJ Hall. Pancytopenia and folate deficiency in alcoholics. Postgrad Med J 1987;63:117–120.
32) Aziz T, Ali L, Ansari T, Liaquat HB, Shah S, Ara J. Pancytopenia: Megaloblastic anemia is still the commonest cause. Pak J Med Sci 2010;26:132-6.
33) Ganti AK, Shonka NA, Haire WD. Pancytopenia due to iron deficiency worsened by iron infusion: a case report. J Med Case Reports. 2007;1:1.
34) Weinzierl EP, Arber DA. The Differential Diagnosis and Bone Marrow Evaluation of New-Onset Pancytopenia. Am J Clin Pathol 2013;139:9-29.
35) Bailey FA, Lilly M, Bertoli LF, Ball GV. An antibody that inhibits in vitro bone marrow proliferation in a patient with systemic lupus erythematosus and aplastic anemia. Arthritis Rheum 1989;32:901-5.
36) Roffe C, Cahill MR, Samanta A, et al: Aplastic anaemia in systemic lupus erythematosus: A cellular immune mechanism? Br J Rheumatol 1991;30:301.
37) Sumimoto S, Kawai M, Kasajima Y, Hamamoto T. Aplastic anemia associated with systemic lupus erythematosus. Am J Hematol 199;38:329-31.
38) Abrams EM, Gibson IW, Blydt-Hansen TD: The concurrent presentation of minimal change nephrotic syndrome and aplastic anemia. Pediatr Nephrol 2009;24:407.
39) Kritharis A, Bastola S, Zhang X, Scott Z. Idiopathic Autoimmune Pancytopenia Treated With Rituximab. Available at: http://www.northshorelij.com/ccurl/341/39/Kritharis.pdf
40) Tariq M, Khan NU, Basri R, Said A. Aetiology of pancytopenia. Professional Med J 2012;17:252-6.
Published
2016-11-07
Section
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