The common causes leading to pancytopenia in patients presenting to tertiary care hospital

Headnote

ABSTRACT

Objective: The objective of this study was to determine the frequency of common causes leading to Pancytopenia in patients presenting to tertiary care hospital at Karachi.

Methods: A total of 62 patients with the diagnosis of Pancytopenia of more than one week duration were enrolled in the study. All patients underwent a detailed medical history and full physical examination followed by blood sampling for the investigations i.e. complete blood count with peripheral film, erythrocyte sedimentation rate (ESR), Malarial parasites (MP), liver function test, Renal function tests, PT and viral profile (HBsAg, Anti-HCV), Ultrasonography of abdomen. All patients underwent bone marrow aspiration and trephine biopsy for reporting and interpretation. Duration of study was six months, from May 2010 to November 2010.

Results: The average age of the patients was 37.76 ± 16.38years. Out of 62 patients, 36 (58%) were male and 26 (42%) were female. Megaloblastic anemia was the commonest cause that was observed in 41.9% cases followed by acute myeloid leukemia 27.4%, aplastic anemia 19.4% and erythroid hyperplasia 11.3%. Conclusion: This study concluded that most common cause of pancytopenia is Megaloblastic anemia, followed by acute myeloid leukemia and aplastic anemia. Bone marrow examination is a single useful investigation which reveals the underlying cause in patients with pancytopenia.

KEY WORDS: Aplastic Anemia, Bone Marrow Biopsy, Megaloblastic Anemia, Pancytopenia.

INTRODUCTION

Pancytopenia is the simultaneous presence of anemia, leucopenia and thrombocytopenia. Therefore it exists when Hemoglobin (Hb) is less then 13.5g/dl in males or 11.5g/dl in females; the leucocytes count is less then 4x1 Oyi and the platelets count is less than 150x1o3/!.1 Initially, mild impairment in marrow function may go undetected and Pancytopenia may become apparent only during times of stress or increased demand (e.g., bleeding or infection). Varieties of hematopoietic and nonhematopoietic conditions manifest with features of pancytopenia. The underlying mechanisms are: decrease in hematopoietic cell production, marrow replacement by abnormal cells, suppression of marrow growth and differentiation, ineffective hematopoiesis with cell death, defective cell formation which are removed from the circulation, antibody mediated sequestration or destruction of cells and trapping of cells in a hypertrophied and over active reticuloendothelial system.2,3

The commonest clinical manifestations of Pancytopenia are usually Fever (86.7%), fatigue (76%), dizziness (64%), weight loss (45.3%), anorexia (37.3%), night sweats (28%),...