Etiological Profile and Clinico-hematological Parameters of Pancytopenia at a University Hospital in Rajasthan

Abstract

Introduction: Pancytopenia is defined as a reduction in the number of red cells, white cells, and platelets. It can manifest as a laboratory finding of many diseases which directly or indirectly affect the bone marrow function. Objectives: The study is aimed to evaluate the etiological causes of pancytopenia in adult patients in a university hospital. Materials and Methods: This is a prospective observational study over a period of one year conducted at a university Hospital in Rajasthan. All adult patients 18 years and above who were admitted due to pancytopenia between June 2021 and May 2022 were included and evaluated for etiology of pancytopenia. After a detailed history and medical examination, basic hematological investigations like complete blood count, reticulocyte count, and peripheral smear examination were performed in each case. Bone marrow aspiration was subsequently carried out in the indicated individuals. The etiological and clinico-hematological correlation was done in all cases before reaching a definitive diagnosis.  Results: A total of 132 patients was evaluated. 76 (57.58%) were male and 56 (42.42%) were female. The mean age was 37.7 years. Easy fatigue and pallor were noted in all (n=132; 100%) patients. Breathlessness (n: 71; 53.78%) and splenomegaly (n: 60; 45.45%) were common clinical features.  The etiological causes of pancytopenia were as megaloblastic anemia (n: 76; 57.58%), aplastic anemia (n: 26; 19.70%), hypersplenism (n: 12; 9.09%), acute leukemia (n: 7; 5.28%), malaria (n: 7; 5.28%), myelodysplastic syndrome (n: 2; 1.5%), and lymphoma (n: 2; 1.5%). Almost half of the patients had severe pancytopenia. Bone marrow examination was indicated in 68(51.5%) patients; although only 57(43.2%) consented for it. Conclusion: The etiological causes of pancytopenia vary depends on patients’ age, gender, nutritional status, infections, and geographical areas. It should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever, and a tendency of mucocutaneous bleed. Serum B12 deficiency is the most common treatable cause of pancytopenia. Most of the etiological causes could be diagnosed with routine hematological investigations, without the need of a bone marrow examination.  Also, many causes of pancytopenia are completely curable while others are manageable.

Key words: Pancytopenia, megaloblastic anemia, hypersplenism, myelodysplastic syndrome, malaria, bone marrow.