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

Abstract

BackgroundPeripheral 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.MethodsThis 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.ResultsA 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.ConclusionDetailed 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.

Etiological profile of pancytopenia in a tertiary care hospital

“…It is not a disease entity, but rather a triad of findings that may result from a number of disease processes. 1 The frequency with which each condition is associated with pancytopenia differs considerably. For example, it is essentially always present at some stage in the course of aplastic anemia, very common in subleukemic leukemia, relatively uncommon in lymphomas and rare in metastatic carcinoma involving bone marrow.…”

“…Pancytopenia is generally equated to aplastic anemia and the prognosis considered grim even in textbooks of hematology. 1,2 Pancytopenia has been discussed along with aplastic anemia, though it was not considered its most common cause. 2 A review of available literature, revealed only few international studies 3 and few Indian studies on common etiological causes of pancytopenia.…”

“…2 A review of available literature, revealed only few international studies 3 and few Indian studies on common etiological causes of pancytopenia. 1 As the severity of pancytopenia and the underlying pathology determines the management and prognosis of these patients, identifying the correct etiopathology in a given case is crucial and helps in implementing timely and appropriate treatment. This study was therefore taken up to find out the common etiological causes of pancytopenia, to determine if a critical analysis of peripheral smear would provide vital clues and to conclude how frequently bone marrow aspiration yields the diagnosis.…”

The etiological spectrum of pancytopenia diagnosed from blood smears examined in the pathology department of a rural tertiary care centre in South India

“…Similar results were also obtained in the study by Kale et al and Jain and Naniwadekar. [14,17] Pancytopenia in chronic liver disease can be due to hypersplenism, megaloblastic anemia, and primary marrow suppression. Hypersplenism is the most common cause of pancytopenia in chronic liver disease.…”

“…It could be stressed here that a careful examination of the blood film is often helpful in giving a lead to the diagnosis and a marrow examination usually establishes the diagnosis. [7] The major causes of pancytopenia include megaloblastic anemia, [3,5,[8][9][10] aplastic anemia, [11][12][13] hypersplenism, [13][14][15][16][17] sub-leukemic leukemia, [5,9] and infections. [8,17] The clinical triad of anemia, leukopenia, and thrombocytopenia in peripheral blood seen in pancytopenia may be due to bone marrow failure or infiltration, pooling and destruction of blood cells in the reticuloendothelial system, ineffective hematopoiesis or very often due to suppression of marrow by cytotoxic drug therapy.…”