Pancytopenia: a clinico hematological study

Abstract

Background: Pancytopenia is a relatively common hematological entity. It is a striking feature of many serious and life-threatening illnesses, ranging from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. The severity of pancytopenia and the underlying pathology determine the management and prognosis. Thus, identification of the correct cause will help in implementing appropriate therapy.

Objectives: To study the clinical presentations in pancytopenia due to various causes; and to evaluate hematological parameters, including bone marrow aspiration.

Materials and methods: It was a prospective study, and 104 pancytopenic patients were evaluated clinically, along with hematological parameters and bone marrow aspiration in Hematology Unit, Department of Pathology, JJMMC, Davanagere, during the period of September 2005 to September 2007.

Results: Among 104 cases studied, age of patients ranged from 2 to 80 years with a mean age of 41 years, and male predominance. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was the predominant blood picture. Bone marrow aspiration was conclusive in all cases. The commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. The commonest cause for pancytopenia was megaloblastic anemia (74.04%), followed by aplastic anemia (18.26%).

Conclusion: Thepresent study concludes that detailed primary hematological investigations along with bone marrow aspiration in cytopenic patients are helpful for understanding disease process and to diagnose or to rule out the causes of cytopenia. These are also helpful in planning further investigations and management.

Keywords: Bone marrow aspiration; megaloblastic anemia; pancytopenia.

Figure 1

Peripheral smear showing macrocytic anemia with hypersegmented neutrophils (Leishman, ×1000)

Figure 2

Bone marrow showing megaloblasts, with royal blue cytoplasm and sieve-like chromatin (Leishman, ×1000)igure 1: Peripheral smear showing macrocytic anemia with hypersegmented neutrophils (Leishman, ×1000)

Figure 3

Bone marrow showing hypocellularity with increased fat and reactive lymphoplasmacytosis (Leishman, ×100)

Figure 4

Bone marrow showing myeloblasts with Auer rod (arrow) (Leishman, ×1000)

Figure 5

Pancytopenic smear showing gametocytes of plasmodium falciparum (arrows) (Leishman, ×400)

Figure 6

Bone marrow showing increased plasma cells with binucleate forms (Leishman, ×1000)