A study of clinico-hematological profile of pancytopenic patients in Central India
Abstract
Background: To segregate the causes of pancytopenia which are easily treatable, from those requiring sophisticated investigations & vigorous treatment, based on clinico-hematological profile of the patients and affordable diagnostic mathods.
Materials and Methods: 180 Pancytopenic patients were evaluated clinically along with hematological parameters, peripheral smears and bone marrow aspiration in the Department of Pathology, GMC, Bhopal for 3 years.
Result: Age range was 5 months-70 years (mean- 26.6 years), with Male preponderance (M: F: 1.76:1). Commonest symptoms were weakness (97.8%), breathlessness (75%) and signs were pallor (98.3%) and splenomegaly (25.5%). Patients who presented with per rectal bleeding, in 46.2% diagnosis was dimorphic anemia thus per rectal bleeding was cause of associated iron deficiency. Commonest peripheral smear finding was microcytic hypochromic picture (27.22 %) & bone marrow was hypercellular (70.00%). Bone marrow aspiration revealed commonest cause was megaloblastic anemia (25%) followed by dimorphic anemia (17.2%) and infections (17.2%). In our study MCV was <100 fl in 12/45 (26.66%) cases of megaloblastic anemia so even if a patient presents with MCV < 100 fl megaloblastic anemia should not be ruled out only on this basis. Sensitivity of peripheral smear for dimorphic anemia was very low 35.48% and specificity was 82.55%, so bone marrow examination should be investigation of choice for inconclusive peripheral smears.
Conclusion: Common causes of pancytopenia were easily treatable and reversible & can be detected by early and affordable diagnostic methods therefore should be considered at higher order in differential diagnosis of pancytopenia.
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References
Lilleyman J. De Gruchy’s Clinical Haematology in Medical Practice. J Clin Pathol. 1990 Apr;43(4):352.
Jella R, Jella V. Clinico-hematological analysis of pancytopenia. Int J Adv Med. 2016;176–9.
Tilak V, Jain R. Pancytopenia--a clinico-hematologic analysis of 77 cases. Indian J Pathol Microbiol. 1999 Oct 1;42(4):399.
Kumar R, Kalra SP, Kumar H, Anand AC, Madan H. Pancytopenia--a six year study. J Assoc Physicians India. 2001 Nov;49:1078–81.
Hamid GA, Shukry SAR. Patterns of pancytopenia in Yemen. J Turk Soc Haematol. 2008 Jun 5;25(2):71–4.
Santra G, Das BK. A cross-sectional study of the clinical profile and aetiological spectrum of pancytopenia in a tertiary care centre. Singapore Med J. 2010 Oct;51(10):806–12.
Gayathri BN, Rao KS. Pancytopenia: A Clinico Hematological Study. J Lab Physicians. 2011;3(1):15–20.
Raphael V, Khonglah Y, Dey B, Gogoi P, Bhuyan A. Pancytopenia: an etiological profile. Turk J Haematol Off J Turk Soc Haematol. 2012 Mar;29(1):80–1.
Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital. BMC Blood Disord. 2013;13:10.
Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. JNMA J Nepal Med Assoc. 2008 Mar;47(169):12–7.
Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta AK. Pancytopenia in children: etiological profile. J Trop Pediatr. 2005 Aug;51(4):236–9.
Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone marrow examination in cases of pancytopenia. J Indian Acad Clin Med 2001Jan-June. 2001;2:1–2.
Gupta V, Tripathi S, Tilak V, Bhatia BD. A study of clinico-haematological profiles of pancytopenia in children. Trop Doct. 2008 Oct 1;38(4):241–3.
Prabhala S, E J, B P, M S, T R. Bone marrow examination in pancytopenia: a study of six years. J Evol Med Dent Sci. 2014 Nov 26;3(65):14189–95.
Pine M, Walter AW. Pancytopenia in Hospitalized Children: A Five-year Review. J Pediatr Hematol Oncol. 2010 Jul;32(5):e192–4.
Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia--a clinico haematological study of 200 cases. Indian J Pathol Microbiol. 2002 Jul;45(3):375–9.
N V, S D. A reappraisal of underlying pathology in adult patients presenting with pancytopenia. Trop Geogr Med. 1992 1992;44(4):322–7.
Azaad MAA, Li Y, Zhang Q, Wang H. Detection of Pancytopenia Associated with Clinical Manifestation and Their Final Diagnosis. Open J Blood Dis. 2015;5(3):17–30.
Imbert M, Scoazec JY, Mary JY, Jouzult H, Rochant H, Sultan C. Adult patients presenting with pancytopenia: a reappraisal of underlying pathology and diagnostic procedures in 213 cases. Hematol Pathol. 1989;3(4):159–67.
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