An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital

BMC Hematology

Manjiri Naniwadekar¹  Arvind Jain² 

[1] Department of Pathology, Krishna Institute of Medical Sciences University (KIMSU), Karad, Maharashtra, India;Laboratory Medicine Department, Imperial College London Diabetes Centre (ICLDC), P.O. Box no. 222464, Al Ain, United Arab Emirates

关键词: Myelodysplastc syndrome;    Plasma cell dyscrasia;    Lymphoma;    Leukemia;    Hypoplastic aplastic anemia;    Megaloblastic anemia;    Myelosuppressants;    Infections;    Hypersplenism;    Pancytopenia;   

Others  :  848373
DOI  :  10.1186/2052-1839-13-10

 received in 2013-03-19, accepted in 2013-10-29,  发布年份 2013

【 摘 要 】

Background

Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. Only a few systematic studies have been published on the topic of pancytopenia, although extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Thus, this study was carried out to investigate for and to identify the causes of pancytopenia, to find out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our findings with those of other similar studies from this part of the world.

Methods

This was a prospective study conducted in the Department of Pathology of a teaching institute and a tertiary care hospital in southern Maharashtra, India, over a period of two years. All the patients referred to the central clinical laboratory for routine complete blood count (CBC) and peripheral smear (PS) examination, from both - the outpatient and the inpatient departments, were screened for pancytopenia. Of these, a total number of 250 cases that fulfilled the diagnostic criteria were selected.

Detailed hematological investigations followed by bone marrow aspiration wherever indicated and possible were performed according to standard methods to ascertain the causes of pancytopenia.

Results

A definite male preponderance was observed, the male to female ratio being 2.6 : 1. The majority of cases were encountered in 3rd and 4th decades. Hypersplenism (29.2%), Infections (25.6%), Myelosuppressants (16.8%) and Megaloblastosis (13.2%) were the four most common causes in this large series on pancytopenia from a single centre in India.

Conclusion

Detailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause, avoiding a battery of unnecessary tests.

【 授权许可】

   
2013 Jain and Naniwadekar; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]de Gruchy GC: Pancytopenia, aplastic anemia. In De Gruchy’s clinical hematology in medical practice, 5th edition. Edited by Firkin F, Chesterman C, Penington D, Rush B. Berlin, Germany: Blackwell Science; 1989:119-136.
• [2]Williams DM: Pancytopenia, aplastic anemia and pure red cell anemia. In Wintrobe’s clinical hematology. 10th edition. Edited by Richard GL, Bithel TC, John F, John WA, John NL. Philadelphia: Lea and Fabiger; 1998:1449-1489.
• [3]Osama I, Baqai HZ, Faiz A, Nisar H: Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach. J Ayub Med Coll Abbottabad 2004, 16:3-7.
• [4]Tilak V, Jain R: Pancytopenia – a clinicohematologic analysis of 77 cases. Indian J Pathol Microbiol 1999, 42:399-404.
• [5]Kumar R, Kalra SP, Kumar H, Anand AC, Madan H: Pancytopenia – a six year study. J Assoc Physicians India 2001, 49:1078-1081.
• [6]Kale P, Shah M, Sharma YB, et al.: Pancytopenia with cellular marrow – a clinical study. J Assoc Physicians India 1991, 39:826.
• [7]Savage DG, et al.: Pancytopenia in Zimbabwe. Am J Med Sci 1999, 317:22-32.
• [8]Iqbal W, Hassan K, Ikram N, Nur S: Aetiological breakup of 208 cases of pancytopenia. J Rawal Med Coll 2001, 5:7-10.
• [9]Khunger JM, Arunselvi S, Sharma U, Ranga S, Talib VH: Pancytopenia – a clinicohematological study of 200 cases. Indian J Pathol Microbiol 2002, 45:375-379.
• [10]Niazi M, Raziq F: The incidence of underlying pathology in pancytopenia – an experience of 89 cases. J Postgrad Med Inst 2004, 18:76-79.
• [11]Hamid GA, Shukry SAR: Patterns of pancytopenia in Yemen. Turk J Hematol 2008, 25:71-74.
• [12]Devi PM, et al.: Clinico-hematological profile of pancytopenia in Manipur, India. J Kuwait Med Assoc 2008, 40:221-224.
• [13]Jalbani A, Ansari IA, Chutto M, Gurbakhshani KM, Shah AH: Proportion of megaloblastic anemia in 40 patients with pancytopenia at CMC hospital Larkana. Medical Channel 2009, 15:34-37.
• [14]Tariq M, Khan NU, Basri R, Said A: Aetiology of pancytopenia. Prof Med J 2010, 17:252-256.
• [15]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.
• [16]Aziz T, Liaquat A, Ansari T: Pancytopenia: megaloblastic anemia is still the commonest cause. Pak J Med Sci 2010, 26:132-136.
• [17]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 Jan - Mar (SI) 2010, 16(1):108-110. Available at: http://www.annalskemu.org/journal/index.php/annals/article/view/172/158 webcite
• [18]Gayathri BN, Kadam SR: Pancytopenia: a clinicohematological study. J Lab Physicians 2011, 3:15-20.
• [19]Raphael V, Khonglah Y, Dey B, Gogoi P, Bhuyan A: Pancytopenia: an etiological profile. Turk J Hematol 2012, 29:80-81.
• [20]Caramel R: A focused approach to anemia. Hosp Pract 1999, 2:71-91.
• [21]Fankule YM: Tropical Splenomegaly (2 parts). Clin Haematol 1981, 10:963-982.
• [22]Haseeb-ul Hasan M, Moinuddin M: Hematological manifestations in HIV-infected persons: literature review. Pak J Med Sci 2003, 19:313-321.
• [23]Kasthuri AS, Sharma S, Kar PK: A study of hematological manifestations of HIV infection. Indian J Sex Transm Dis 2006, 27:9-16.
• [24]James J, Dutta TK, Jayanthi S: Correlation of clinical & hematologic profiles with bonemarrow responses in typhoid fever. Am J Trop Med Hyg 1997, 57:313-316.
• [25]Sood R, Roy S, Kaushik P: Typhoid fever with severe pancytopenia. Postgrad Med J 1997, 73:41-42.
• [26]Pathak R, Sharma A, Khanal A: Enteric fever with severe pancytopenia in a four year girl. J Nepal Med Assoc 2010, 50:313-315.
• [27]Chaplin H, Sagel S: Clinicopathologic conference – pancytopenia and hepatosplenomegaly in a 69 year old woman. The Am J of Med 1991, 90:740-749.
• [28]Hunt BJ, Andrews V, Pettingale KW: The significance of pancytopenia in military tuberculosis. Postgrad Med J 1987, 63:801-804.
• [29]Kashyap R, Chaudhary VP: Hematological manifestations of tuberculosis. In Tuberculosis. Edited by Sharma SK, Mohan A. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2006:370-379.
• [30]Glasser RM, Walker RI, Heroin JC: The significance of hematological abnormalities in patients with tuberculosis. Arch Intern Med 1970, 125:691-695.
• [31]Agarwal AK, Chugh IM, Panjabi C, Dewan S, Shah A: Asymptomatic aplastic anemia in a patient receiving anti-tuberculosis treatment. Ind J Tub 2001, 48:97-100.
• [32]Farahmand F, Falahi GH, Shahraki T, Khatami GR, Izadiar M, Ramiar GA: Hepatitis-associated aplastic anemia. Govaresh 2005, 10:54-58.