DOI: http://dx.doi.org/10.18203/2349-3933.ijam20192083

Pancytopenia: the perspective from Western Gujarat, India

Shubhangi V. Deshpande, Varsha Y. Godbole, Archana D. Asher

Abstract


Background: Pancytopenia is one of the common laboratory findings in patients presenting to us with varied clinical presentations. Risks of untreated Pancytopenia are high causing anxiety to treating doctors and patients alike. It also involves long list of investigations including a very painful marrow biopsy, life-threatening complications and treatment involves multiple blood component therapy. A total of 101 cases of pancytopenia over a period of 1 year were analysed retrospectively to find i) commonest presenting symptoms ii) commonest cause of pancytopenia, response to treatment iii) Depending on the cause, to consider if any measures can be taken for prevention

Methods: Cross sectional study of 101 admitted patients of Pancytopenia on the basis of information extracted from the case sheets. The data was analyzed and presented as frequencies and Percentages.

Results: Out of 101 cases analysed, 53 (52.47%) were females 48 (47.52%) patients males. Fatigue 74 patients (73.2%) was the commonest presenting symptom followed by fever 33 (32.6%), breathlessness 13 (12.87%) and bleeding 4(3.8%). Vitamin B12 deficiency 58 (57.6%) patients showed and was the commonest cause of pancytopenia. Infections in 24 (23.7%) like malaria16 (15.6%), dengue 5 (4.96%), PLHA 1(0.96%) and hepatitis B 2 (1.96%) was the second common cause in present study. Recovery of pancytopenia was prompt in Malaria Dengue. HIV, Hepatitis B viral infection showed persistent pancytopenia with hypoplastic marrow. Chronic liver disease portal hypertension splenomegaly accounted for 9 (8.9%) patients. Drug induced marrow suppression due to ongoing treatment for underling disease resulted in pancytopenia in 4 (3.96%) patients. Aplastic anaemia in3 (2.9%), myelodysplastic syndrome 2 (1.9%) and acute leukaemia 1 (0.96%) were the less common causes.

Conclusions: Commonest symptom on presentation were related more to anaemia than to neutropenia and thrombocytopenia. megaloblastic anaemia due to Vitamin B12 deficiency was the leading reversible cause of pancytopenia in present study followed by infections like Malaria Dengue. Gujarat, India being predominantly vegetarian state, local dietary habits are thought to be responsible for inadequate B12 daily consumption, hence we suggest fortifying the daily diet with B12 supplementation at a larger scale just like iodisation of salt to counter iodine deficiency.


Keywords


Bone marrow studies, B12 deficiency, Megaloblastic anaemia, Pancytopenia

Full Text:

PDF

References


Watson, Henry G, eds. Blood disease. Davidson’s principles and practice of medicine. Amsterdam: Elsevier Health Sci. 2013;989-1056.

Garg AK, Agarwal AK, Sharma GD. Pancytopenia: Clinical approach; Chapter 95:450-454. Available at: www.apiindia.org/pdf/medicine_update_2017/mu_095.

Harrison’s Principles of internal medicine14th ed. 634-8;672-8.

Imbert M, Scoazec JY, Mary JY, Jouzult H, Rochant H, Sultan C. Adult patients presenting with pancytopenia: a reappraisal of underlying pathology and diagnostic procedures in 213 cases. Hematol Pathol. 1989;3(4):159-67.

Tilak V, Jain R. Pancytopenia-a clinico-hematologic analysis of 77 cases. Indian J Pathol Microbio. 1999;42(4):399-404.

Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia-a clinico haematological study of 200 cases. Indian J Pathol Microbio. 2002;45(3):375-9.

Iqbal W, Hassan K, Ikram N, Nur S. Aetiological breakup in 208 cases of pancytopenia. J Rawal Med Coll. 2001;5(1):7-9.

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(1):132-6.

Qazi RA, Masood A. Diagnostic evaluation of pancytopenia. J Rawal Med Coll. 2002;6.30-33:269-274

Gupta M, Chandna A, Kumar S, Kataria SP, Hasija S, Singh G, Sen R. Clinicohematological Profile of Pancytopenia: A Study from a tertiary care Hospital. Dicle Med J. 2016;43(1).

Sarin YK. Dengue viral infection. Indian pediatrics, 1998 Feb:35. Available at: medind.nic.in/ibv/t98/i2/ibv.

Lakhotia M, Pahadiya HR, Gandhi R, Prajapati GR, Choudhary A. Stuck with pancytopenia in dengue fever: Evoke for hemophagocytic syndrome. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2016 Jan;20(1):55.

Agarwal R, Bharat V, Gupta BK, Jain S, Bansal R, Choudhary A, et al. Clinical and hematological profile of pancytopenia. Intern J Clin Biochem Res. 2015;2(1):48-53.

Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia-largest series reported to date from a single tertiary care teaching hospital. BMC Blood Disord. 2013;13(1):10.

Varma N, Dash S. A reappraisal of underlying pathology in adult patients presenting with pancytopenia. Trop Geograph Med. 1992;44(4):322-7.

Kumar R, Kalra SP, Kumar H, Anand AC, Madan H. Pancytopenia-a six year study. J Assoc Physic India. 2001;49:1078-1.

Memon S, Shaikh S, Nizamani MA. Etiological spectrum of pancytopenia based on bone marrow examination in children. J Coll Physic Surg Pak. 2008;18(3):163-7.

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(10):806.

Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. J Nepal Med Assoc. 2008;47(169):12-7.

Ghartimagar D, Ghosh A, Thapa S, Sapkota D, Jhunjhunwala AK, Narasimhan R, et al. Clinicohematological study of pancytopenia in a tertiary care hospital of Western Region of Nepal. J Nepal Med Assoc. 2017;56(207).