Diagnostic evaluation of pancytopenia - a prospective institutional study in North-East India
Abstract
Introduction: Pancytopenia, the simultaneous reduction of all the three formed elements of blood, is diverse in its etiology. Full clinico-hematopathological work up is crucial in each case. This study was undertaken with the objectives of identifying the causes of pancytopenia and its phenotypic characteristics in relation to age, sex, ethnicity and socio- economic status.
Methods: Ninety two cases of pancytopenia studied here were diagnosed by complete hemogram study in automated hematology analyzer. Peripheral blood smear studies were carried out. All cases were subjected to bone marrow aspiration/ imprint smear cytology and trephine biopsy study. Hypoplastic anemia cases were investigated for paroxysmal nocturnal hemoglobinuria (PNH) with flow cytometric analysis of red blood cells treated with CD55 and CD59 antibodies.
Results: Fifty eight percent of cases were males and mean age was 52 years. Children constituted 16% of patients. Thirty-seven percent of cases belonged to tribal community. Around 70% belonged to low socio-economic status. Causes of pancytopenia detected were primary hematological malignancies (Total 39.2 % with acute leukaemia 35.9%, lymphoma 2.2% and multiple myeloma 1.1%), hypoplastic anaemia (28.3%), myelodysplastic syndrome (MDS) (21.7%), megaloblastic Anemia (6.5%) and hypersplenism (4.3%). No PNH clone was detected amongst hypoplastic anemia cases.
Conclusion: It is concluded that pancytopenia often is the manifestation of serious disease-processes and the commonest cause, in our population of this North-Eastern state of Tripura, being acute leukemia. Bone marrow cytology and biopsy study must be performed in all cases of pancytopenia to find out the cause in order to institute an early treatment.
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