Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India

Varma, Amit; Lokwani, Prince; Malukani, Kamal; Gupta, Sudarshan; Maheshwari, Parul

doi:10.4103/mjdrdypu.mjdrdypu_52_18

Cited by 4 publications

(4 citation statements)

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“…In the present study, the most common clinical history observed was fever followed by generalised weakness, pallor, bleeding, portal hypertension, etc. These clinical findings were found similar in Rangaswamy M et al,[17] and Varma A et al, [18]. The most common sign was splenomegaly followed by hepatosplenomegaly and hepatomegaly, while there was no organomegaly in 35.7% of patients.…”

Section: Resultssupporting

confidence: 87%

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Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology

Kumar¹,

Shelke²,

Doshi³

et al. 2023

NJLM

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Introduction: Reduced numbers of all three types of peripheral blood cells characterise the hematologic condition known as pancytopenia. Practical distinction among various causes of pancytopenia is usually clear but some processes are so closely related that the diagnosis may get complicated and bone marrow examination aids in diagnosis of such cases.It is important to recognise marrow failure syndromes causing pancytopenia. Pancytopenia is a common finding, its explicit discussion is lacking even in major textbooks and has led many authors to highlight the spectrum of causes of pancytopenia. Aim: To evaluate the various causes of pancytopenia and to evaluate clinical signs and symptoms, hematological parameters along with bone marrow cellularity and other morphological features on aspiration and trephine biopsy in patients presenting with pancytopenia. Materials and Methods: In the present cross-sectional study for a period of 3.5 years from August 2018 to April 2022, a total 157 patients were included having pancytopenia in a tertiary care centre, Pune, Maharashtra, India. Clinical history was taken for all the cases of pancytopenia. The blood samples were collected for hematological analysis including hemogram and Peripheral Blood Smear (PBS) examination; also Bone Marrow (BM) samples were collected. Aspirates were stained with Leishman and Giemsa. Special stains like myeloperoxidase (MPO) and Periodic acid schiff stain (PAS) were used wherever required. Bone marrow biopsy was fixed in Bouin’s fluid and processed and stained with Haematoxylin and eosin (H&E) and reticulin stain after decalcification. Results were analysed using Statistical Package for the Social Sciences (SPSS) software (version 26.0) and calculated as frequencies and percentages. P-value of <0.05 was considered significant. Results: Out of 157 patients, majority (n=120) belonged to adult age group (18-86 years) (76.43%), with the mean age of 40.68±23.34 years. The male to female ratio was 1.34:1. Study showed megaloblastic anaemia encompassing majority of the causes of pancytopenia followed by acute leukemia, hypersplenism, hypocellular marrow, Hemophagocytic lymphohistiocytosis (HLH), myelodysplastic syndrome (MDS) and Aplastic anaemia. Out of 86 (54.78%) of total majority of hypercellular bone marrow patients, 51 (59.3%) had haemoglobin levels of <7 g/dL, while 45 (52.32%) hypercellular bone marrow patients had platelet count of <50000 cells/cumm. Patients with low TLC weresignificantly associated with hypo (p=0.0067) and hypercellular marrow (p=0.0291) compared to normocellular marrow. For reticulocyte count an increasing trend with low reticulocyte count was seen from normocellular (n=4, 6.9%) to hypocellular (n=12, 20.7%) to hypercellular (n=19, 32.8%) bone marrow,though it was not statistically significant. Conclusion: It was concluded in the present study that megaloblastic anemia was the most common etiology of pancytopenia and the commonest clinical symptoms observed was fever.

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Section: Resultssupporting

confidence: 87%

“…Male to female ratio was 1.34: 1.0 to a study by an almost equal gender distribution among patients with pancytopenia. Different studies from central India are shown in cite references [9,[14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology

Kumar¹,

Shelke²,

Doshi³

et al. 2023

NJLM

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“…However, similar results have been reported in studies from other Indian centres. Imbert M et al 9 Varma N, Dash S 10 Tilak V, Jain R 5 Khodke et al 11 Naeem Khan M et al 12 Kumar R et al 13 Osama Ishtiaq et al 14 Mobina et al 15 Jha et al 16 Varma A et al 17 Present study…”

Section: Discussionmentioning

confidence: 85%

Clinico-Etiological and Clinico-Haematological Study of Patients with Pancytopenia in Rural Area

Karamchedu¹,

Reddy²,

Fatima³

et al. 2023

Acta Medica Martiniana

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Background Pancytopenia is a manifestation of other underlying conditions, commonly associated with multiple benign and malignant conditions. Any patient presenting with pancytopenia requires a thorough evaluation to identify the underlying aetiology. Aim This current evaluates various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia in adult group. Study also correlates clinico-haematological profile. Method Fifty patients with a hematological diagnosis of pancytopenia were studied during the period August 2020 to August 2022. The study included adult patients of both sexes having the age of 18 years and above. Tests for complete blood count, reticulocyte count, peripheral smear, bone marrow aspiration, and trephine biopsy were done. Results Various etiological factors were identified in which majority were of megaloblastic anaemia (48.9%), followed by mixed nutritional anaemia (22.2%), hypersplenism (13.3%), aplastic anaemia (8.9%), malignant conditions (6.7%), myelodysplastic syndromes (2%), and others (4%) respectively. Megaloblastic anaemia cases observed in the age group of 31–50 years with male preponderance. Hemoglobin, TLC, Platelet count, and Reticulocyte count ranged from 2 g% - 10g%, 500–4000 cells/cumm, 24,000–1.5 lakh cells/cumm, and 0.1% – 2%. MCV was higher than 100 fl in 57.5% of cases. Majority of the patients had macrocytic and dimorphic anaemia. Hypersegmented neutrophils were present in all the patients. Bone marrow of Megaloblastic anaemia was hypercellular. Megaloblastic erythropoiesis with giant meta- myelocytes and band forms were seen. Nutritional anaemia seen in the age group of 51-60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 2.3 g%–7.8 g%, 1000–4000 cells/cumm, 5000–1.4 lakh cells/cumm, and 0.1–8%. Two cases had microcytic hypochromic anaemia in Nutritional anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 93.8% of cases. In hypersplenism seen in the age group of 51–60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.8 g% – 10 g%, 1700–3800 cells/cumm, 26000-1.4 lakh cells/cumm, and 0.6–2% respectilvey in hypersplenism. 40% of hypersplenism patients had microcytic hypochromic anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 70% of hypersplenism cases. Aplastic anaemia seen in the age group of 41–50 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.1–10 g%, 1100–4000 cells/cumm, 51000–1.5lakh cells/cumm, and 0.2%–1.8%. Aplastic anaemia (35.8%) cases showed macrocytosis. Bone marrow was hypocellular with an increase in marrow fat and Lymphocytes and plasma cells were prominent in Aplastic anaemia cases. Leukaemia commonly seen in the age group of 31–40 years with male predominance. Hemoglobin, TLC, and Reticulocyte count ranges from 5.1–9.8%, 1100–4000 cells/cumm, and 0.6–2% respectively. Bone marrow was hypercellular with a reversal of M:E ratio in 80%. Conclusion Megaloblastic anaemia was the commonest cause of pancytopenia. Most other studies have reported aplastic anaemia as the commonest cause. This seems to reflect the higher prevalence of nutritional anaemia in the Indian subjects. The haematological parameters and bone marrow morphological features in patients with megaloblastic anaemia, aplastic anaemia, and malignant diseases including MDS in the present study were comparable to the findings by other authors. Uncommon etiological factors like dengue fever and hemolytic anaemia were identified in this study. A comprehensive clinical, haematological, and bone marrow study of patients with pancytopenia usually helps in identification of the underlying cause. However, in view of a wide array of etiological factors, pancytopenia continues to be a challenge for hematologists.

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“…In a study of 251 patients by Varma et al, the common cause of pancytopenia was megaloblastic anemia (39%) followed by dimorphic anemia (14%) and aplastic anemia (7%). IDA was the fourth etiology of pancytopenia in 5.9% (15/251) cases [ 18 ]. In another Indian study, IDA was the third common cause of pancytopenia and 70% of cases were treatable with complete recovery from pancytopenia [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India

Meena,

Khichar,

Pawar

et al. 2023

Cureus

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Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. Methods: This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin. Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. Conclusion: Severe iron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopenia if common causes of pancytopenia are ruled out.

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Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India

Cited by 4 publications

References 1 publication

Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology

Bone Marrow Cellularity in Pancytopenia- A Paradigm of Underlying Pathology

Clinico-Etiological and Clinico-Haematological Study of Patients with Pancytopenia in Rural Area

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India

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