CLINICO HAEMATOLOGICAL STUDY IN CASES OF PANCYTOPENIA
##plugins.themes.academic_pro.article.main##
Abstract
Aims and Objectives: To study the various causes of pancytopenia in our region and assess the haematological and bone marrow findings in various cases of pancytopenia.
Materials and Methods: The study is of prospective and analytical type, conducted on patients attending outpatient and inpatient department of AVBRH, tertiary care centre. All the cases irrespective of age and sex with pancytopenia were included in this study. Peripheral smear was used for morphological classification and typing of anemia. Bone marrow aspiration was then carried out under all aseptic precautions and slides were stained with leishmans stain. Cytochemistry was done using Myeloperoxidase stain and Periodic Acid and Schiff reagent stain were performed where necessary. Significant parameters like aetiology, age, gender, clinical features, hematological parameters, peripheral blood film, bone marrow aspiration findings in different cases of pancytopenia were compared with various studies published in literature.
Results: A detailed peripheral blood smear examination was done on all patients. Megaloblastic anemia had 28 cases, 11 patients of acute leukemia immature cells, aplastic anemia had total 5 cases. The commonest bone marrow finding was megaloblastic anaemia 28(52.8%), followed by acute leukemia 11(20.8%) and normoblastic erythroid hyperplasia 6(11.3%), aplastic anaemia5(9.4%) other causes were mixed nutritional anaemia, multiple myeloma and Non hodkins lymphoma all had 1(1.9%) case each.
Conclusion: In our country main cause of pancytopenia being fortunately megaloblastic anaemia which responds very well to treatment if diagnosed correctly in time. The present study concludes that detailed haematological investigations along with bone marrow examination in cytopenic patients are not only helpful in understanding the disease process but also to diagnose or to rule out the causes of pancytopenia and planning further investigations and management of these patients.
##plugins.themes.academic_pro.article.details##
References
-
1. Varma A, Lokwin P, Malukani K, Gupta S, Maheshwari P. Study of haematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India. Med J DY Patil Vidyapeeth 2018;11:512-8
2. Williams MD. Wintrobe’s Clinical Haematology. In: Lee RG, Foerster J. Lukens J, Paraskevas F, Greer JP, Rodgers GM, editors. Pancytopenia, aplastic anaemia and pure red cell aplasia. 10th ed. Williams and Wilkins; 1997:1449-476.
3. Pancytopenia: aplastic Anemia. deGruchy’s Clinical Hematology in Medical Practice. Wiley India edition. (6th Edition).2013; Chapter 6: 106-1192
4. Ahmed M, Anand M, Kumar A, Siddiqui MKJ. Childhood aplastic anaemia in Lucknow, India: Incidence, organochlorines in the blood and review of case reports following exposure to pesticides. Clinical Biochemistry 2006;39:762-766
5. Gupta V, Tripathi S, Tilak V, Bhatia BD. A study of clinico- haematological profiles of pancytopenia in children. Trop Doct 2008; 38:241-3
6. Nelsons Textbook of Paediatrics, Nineteenth edition, Pages 1642-1645
7. John Greer, John Foester, George M Rodgers, F'lxos Paraskevas, Wintrobes Clinical Haematology, 2009; Pages 1188-1189
8. Hayat, A.S., Khan, A.H., Baloch, G.H. and Shaikh, N. (2014) Pancytopenia: Study for Clinical Features and Etiologi- cal Pattern of at Tertiary Care Settings in Abbottabad. The Professional Medical Journal, 21, 060-065.
9. Kumar, abbas, Fausto and Aster; Pathological bases of disease- Eighteen Edition - Pages 744.
10. Desalphine, M., Bagga, P.K., Gupta, P.K. and Kataria, A.S. (2014) To Evaluate the Role of Bone Marrow Aspiration and Bone Marrow Biopsy in Pancytopenia. Journal of Clinical and Diagnostic Research, 8, FC11-FC15. http://dx.doi.org/10.7860/jcdr/2014/9042.5169].
11. Raja, S., Suman, F.R., Scott, J.X., Latha, M.S., Rajenderan, A. and Ethican, A. (2015) Pancytopenia: An Obstacle in the Diagnosis and Outcome of Pediatric Acute Lymphoblastic Leukemia. South Asian Journal of Cancer, 4, 68-71.
12. Tilak V, Jain R. Pancytopenia-A Clinco-hematologic analysis of 77 cases. Indian J Pathol Microbiol. 1999;42:399–404.
13. Kumar R, Kalra SP, Kumar H, Anand AC, Madan M. Pancytopenia-A six year study. J Assoc Physicians India. 2001;49:1079–81.
14. Hematology: Basic Principles and Practice, Expert Consult Premium Edition ...By Ronald Hoffman, Edward J. Benz Jr., Leslie E. Silberstein, Helen Heslop, Jeffrey Weitz, John
15. Incidence of Aplastic Anemia: The Relevance of Diagnostic Criteria 1718 Blood, Vol 70, No6 (December), 1987: pp 1718-1721 By the International Agranulocytosis and Aplastic Anemia Study
16. De Gruchys Clinical Haematology in Medical Practice (English) 6th Edition (DE GRUCHY;S CLINICAL HAEMATOLOGY IN MEDICAL PRACTICE, Renu Saxena, Colin Chesterman, Hara Prasad Pati, Manoranjan Mahapatra, Frank Firkin, David Penington, Bryan Rush
17. Pathak R1, Jha A1, Sayami G11 Department of Pathology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
18. Aseem S, Varma N, Das R, Ahluwalia J, Sachdeva Mu, Marwaha Rk. Pediatric Patients With Bicytopenia/Pancytopenia: Review Of Etiologies And Clinico-Hematoiogical Profile At A Tertiary Center. Indian J Pathol Microbiol 2011; 54: 75-80
19. Park GT, Jean DW, Roh KH et al. A case of pancytopeniasecondary to low – dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiancy. Korean Journal of Internal Medicine 1999; 14 (1): 85-7.
20. Craig JIO, McClelland DBL, Ludman CA. Blood disorders.In:BoonN, Colledge N, Walker B,Hunter J,editors. Davidsons Principles and Practice of Medicine.20th.ChurchillLivingstone; 2010.p-1019.synopsis Bangalore
21. Young NS, Barrett AJ. The treatment of severe acquired aplastic anaemia. J Am Soc of Hematol1995; 85: 3367-77.
22. Williams MD. Pancytopenia, aplastic anemia and pure red cell aplasia. In: Lee RG, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM, (eds). Wintrobe’s Clinical Haematology 10th edn. Williams and Wilkins;1997. pp1449-76. pathak sayami nepal
23. Mckenna RW, Kroft SH. Disorders of bone marrow. Mills SE, Carter D, Greenson JK, Reuters VE, Stoler MH, (eds). In: Sternberg’s Diagnostic Surgical pathology. 5th edn. Kluwer Lippincott; Wiliams and Wilkins; 2010. pp611-4.pathak sayami Nepaltol1995; 85: 3367-77.
24. Camitta BM, Storb R, Thomas ED. Aplastic anemia :pathogenesis, diagnosis, treatment and prognosis. Engl J Med s1982; 306: 645-52,
25. Trivette, E.T., Hoedebecke, K., Berry-Cabán, C.S. and Jacobs, B.R. (2013) Megaloblastic Hematopoiesis in a 20-Year- Old Pregnant Female. American Journal of Case Reports, 14, 10-12. http://dx.doi.org/10.12659/AJCR.883734
26. Rannelli, L., Watterson, R., Pandya, R. and Leung, A.A. (2014) Vitamin B12 Deficiency with Combined Hematologi- cal and Neuropsychiatric Derangements: A Case Report. Journal of Medical Case Reports, 8, 277..
27. Kumar, D.B. and Raghupathi, A.R. (2012), Clinicohematologic analysis of pancytopenia: Study in a tertiary care centre. Basic and Applied Pathology, 5: 19-21.
28. Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta AK. Pancytopenia in children: Etiological profi le. J Trop Pediatr 2005;51:236-9.
29. Aziz T, Ali L, Ansari T, Liaquat HB, Shah S, Ara J. Pancytopenia: Megaloblastic anemia is still the commonest cause. Pak J Med Sci 2010;26(1):132-136
30. Jha et al. Bone Marrow Examination in Cases of Pancytopenia, J Nepal Med Assoc 2008;47(169):12-7
31. Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow Examination in Cases of Pancytopenia. JIACM 2001;2:55-59.
32. Gayathri BN, Rao KS. Pancytopenia: A clinico hematological study. J Lab Physicians 2011;3:15-20.
33. Makheja KD, Maheshwari BK, Arain S, Kumar S, Kumari S, Vikash. The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci 2013;29(5):1108-1111.
34. Yadav A, Nigam R K, Malik R. A study of clinico-hematological profile of pancytopenic patients in Central India. Int J Med Res Rev 2017;5(05):484-491.
35. Rangaswamy M, Prabhu, Nandin NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc 2012;110:560-2
36. Chandra, Kalpana, and Praveen Kumar. "MORPHOLOGICAL SPECTRUM OF BONE MARROW IN PANCYTOPENIA--A RETROSPECTIVE STUDY IN A TERTIARY CARE CENTRE." Journal of Evolution of Medical and Dental Sciences, vol. 3, no. 4, 27 Jan. 2014, pp.