A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

Authors

  • Janak G. Chokshi Department of Medicine, Dr. M. K. Shah Medical College and Research Center, Chandkheda, Ahmedabad, Gujarat, India
  • Bhargavkumar I. Patel Department of Medicine, Dr. M. K. Shah Medical College and Research Center, Chandkheda, Ahmedabad, Gujarat, India
  • Ishvarlal M. Parmar Department of Medicine, Dr. M. K. Shah Medical College and Research Center, Chandkheda, Ahmedabad, Gujarat, India
  • Dipen R. Damor Department of Medicine, Dr. M. K. Shah Medical College and Research Center, Chandkheda, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20201080

Keywords:

Megaloblastic anemia, Myelodysplastic syndrome, Pancytopenia, Vitamin B12 deficiency

Abstract

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.

Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.

Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.

Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

References

Imbert, et.al. Adult patients presenting with pancytopenia. Hematol Pathol. 1989;3(4):159-67.

Kumar R, Karla SP, Kumar H, Anand AC, Madan M. Pancytopenia- A six year study. JAPI. 2001;49:1079-81.

Rangaswamy M, Prabhu, Nandini NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc. 2012;110:560-2, 566.

Shah SP, Raj GA, Rizal S, Karki P. Clinico- Hematological and management profile of aplastic anemia- A first series of 118 cases from Nepal. Singapore Med J. 1999;(40):07.

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.

Hamid GA, Shukry SA. Patterns of pancytopenia in Yemen. Turk J Hematol. 2008;25:71-4.

Retief FP, Heyns AD. Pancytopenia and aplastic anemia: A retrospective study. S Afr Med J. 1976;50:1318-22.

Tilak V, Jain R. Pancytopenia – A clinico-hematologic analysis of 77 cases. Indian J Pathol Microbiol. 1999;42:399-404.

Premkumar M, Gupta N Singh T. Cobalamin and folic acid status in relation to the etiopathogenesis of pancytopenia in adults at a tertiary care centre in North India. Anemia. 2012;2012:707402.

Hauswirth AW, Skrabs C, Schützinger C, Gaiger A, Lechner K, Jäger U. Autoimmune hemolytic anemias, Evans' syndromes, and pure red cell aplasia in non-Hodgkin lymphomas. Leuk Lymphoma. 2007;48:1139-49.

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

Perkins SL. Normal Blood and Bone Marrow values in humans. In: Lee GR, Foerster J, Lukesns J, Paraskenas F, Greev JP, Rodgers GM, edts. Wintrobes clinical Hematology, 10th edn, Maryland: Williums and Wilkins; 1999:2738-2748.

Zeldis JB, Dienstag JL, Gale RP. Aplastic anemia and non-A, non-B hepatitis. Am J Med. 1983 Jan 1;74(1):64-8.

Kim M, Lee SE, Park J, Lim J, Cho BS, Kim YJ, et al. Vitamin B (12)-responsive pancytopenia mimicking myelodysplastic syndrome. Acta Haematol. 2011;125:198-201.

Yokuþ O, Gedik H. A case with pancytopenia and autoimmune hemolytic anemia due to Vitamin B12 deficiency. J Blood Disord Transfus. 2015;S5:002.

Sari I, Altuntas F, Hacioglu S, Kocyigit I, Sevinc A, Sacar S, et al. A multicenter retrospective study defining the clinical and hematological manifestations of brucellosis and pancytopenia in a large series: Hematological malignancies, the unusual cause of pancytopenia in patients with brucellosis. Am J Hematol. 2008;83:334-9.

Mert A, Ozaras R, Tabak F, Bilir M, Ozturk R, Aktuglu Y. Malaria in Turkey: A review of 33 cases. Eur J Epidemiol. 2003;18:579-82.

Klco JM, Geng B, Brunt EM, Hassan A, Nguyen TD, Kreisel FH, et al. Bone marrow biopsy in patients with hepatitis C virus infection: Spectrum of findings and diagnostic utility. Am J Hematol. 2010;85:106-10.

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Published

2020-03-21

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Original Research Articles