New onset pancytopenia in adults: a review of underlying pathologies and their associated clinical and laboratory findings

Abstract

Pancytopenia is regularly encountered in hematology practice, yet there exist few published assessments of the frequencies of various etiologies, and these frequencies exhibit substantial geographic variation. We reviewed bone marrow specimens from pancytopenic adults to determine the most common etiologies and to identify associations with clinical and laboratory findings. Of 132 patients with no history of hematolymphoid neoplasia, no prior bone marrow study for pancytopenia and no recent cytotoxic chemotherapy, 64% had clonal hematopoietic disorders. Most common were myeloid processes: 26% of patients had acute myeloid leukemia, and 17% had myelodysplasia. Less common were lymphoid neoplasms such as non-Hodgkin lymphoma (6%), hairy cell leukemia (5%) and precursor B acute lymphoblastic leukemia (4%). Among non-clonal cases, the most common specific diagnoses were aplastic anemia (5%), megaloblastic anemia (2%) and human immunodeficiency virus (HIV)-related changes (2%). Clonal diagnoses were associated with more severe cytopenias than non-clonal cases. Circulating nucleated erythroid precursors, immature granulocytes and blasts were seen more frequently in clonal cases. Nearly two-thirds of cases of new onset pancytopenia in adults in our North American practice setting have a clonal etiology, with myeloid neoplasms being most common. Blood counts and peripheral smear findings can provide insights into the likelihood of a clonal etiology.

Identification of immature granulocytes in cancer chemotherapy patients by cell counting vs. microscopic examination of blood smears

“…Toxic changes and degenerative changes were observed in the granulocytes of these patients, which may be a significant reason for the false-positive results in the automated measurement. Blood counts and peripheral smear findings may provide insight into the likelihood of a clonal etiology (7).…”

Bone marrow examination in Egyptian patients with bicytopenia/pancytopenia

“…This means that bicytopenia is as important as pancytopenia being associated with clonal disorders (commonly, lymphoid neoplasms) in about one third of cases. In Western studies, nearly two thirds of adult cases with new onset pancytopenia had a clonal etiology; however, myeloid neoplasms were the most common (Imbert et al 1989;Devitt et al 2014). Hypersplenism was seen in 27 % of pancytopenia patients and 18 % of bicytopenia patients.…”

“…A wide variety of disorders can cause pancytopenia; however, the frequency with which each condition is associated with pancytopenia differs according to geographical distribution and genetic differences (Devitt et al 2014). In the present study, the most common cause of pancytopenia was found to be clonal hematopoietic disorders (34 %), followed by hypersplenism (27 %) and then aplastic anemia (21 %).…”

“…In Asian countries, aplastic anemia was the commonest cause of pancytopenia that was detected in 29-79 % of cases (Jha et al 2008;Biswajit et al 2012;Kumar and Raghupathi 2012;Khan et al 2013). In Western studies, the incidence of aplastic anemia among pancytopenia patients was found to be 5-10 % (Imbert et al 1989;Devitt et al 2014). …”

“…The incidence of diseases that cause pancytopenia differs according to geographical distribution and genetic differences (International Agranulocytosis and Aplastic Anemia Study 1987). There are several published studies that explored bone marrow pictures in cases of pancytopenia (Gayathri and Rao 2011;Naseem et al 2011;Doshi et al 2012;Rangaswamy et al 2012;Khan et al 2013;Weinzierl and Arber 2013;Devitt et al 2014); none of them is Egyptian. To the best of our knowledge, no study has analyzed adult bicytopenia patients.…”