Clinical Profile and Etiopathological Causes of Bicytopenia and Pancytopenia in A Tertiary Care Hospital in South India

Abstract

Review and Background :

Pancytopenia is a hematologic condition characterized by a decrease in all three peripheral blood lineages. Bicytopenia is the condition where there is a decrease in two of the hematopoietic lineages. Both pancytopenia and bicytopenia are usually a manifestation of one of a variety of diseases which may affect the bone marrow. Pancytopenia in particular, is a strong indicator for bone marrow examination. Effective treatment heavily depends on accurately diagnosing the etiology of the same.

Aim and Objectives :

1) To generate data on the clinical profiles and etiological causes of pancytopenia and bicytopenia in South India.

2) Analyze the use of bone marrow examination in the diagnosis of hematological malignancies.

Methodology :

The data was retrieved from medical records and LIS system of the institution. We used the WHO approved criteria of anemia to classify cases into four categories; mild, moderate, severe and life threatening anemia. We further sub classified the data into bicytopenia and pancytopenia and analyzed the data for significant correlation.

Statistics :

The data retrieved was tabulated and represented in percentages, measures of central tendency and analyzed statistically for correlation between the severity of anemia and disease outcome using T - Test and  ANOVA interpretation. The descriptive statistics for the tests were represented as graphs and charts.

Results :

During the period of January 2020 to December 2022, we encountered 414 cases of cytopenias coming under the inclusion criteria. 317 cases were of Bicytopenia and 97 cases were of Pancytopenia. The most commonly observed bicytopenia is anemia with thrombocytopenia followed by anemia with leukopenia and leukopenia with thrombocytopenia. The mean age of cases in our study population was 56 yrs with a male preponderance. In pancytopenia, there was strong correlation between hemoglobin with total count and platelet count. We also observed that the most common cause of pancytopenia was megaloblastic anemia followed by multiple myeloma. The most common cause of bicytopenia was infections followed by Multiple myeloma and Myeloproliferative Neoplasm.

Conclusion :

A strong clinical suspicion with the presence of leukocytosis, life threatening to severe anemia, leukoerythroblastic blood picture, and the presence of blasts almost always warrants a bone marrow aspiration. The absence of the same excludes the necessity for bone marrow examination. From our research, we infer that a case of chronic bicytopenia not improving on treatment must be evaluated for hematological malignancies. Many indolent hematological malignancies in our study presented with mild anemia or mild bicytopenia. 8.2 % of cases turned out to be indolents  hematological malignancy such as Myeloproliferative neoplasm, Myelodysplasia etc. Progressive anemia with thrombocytopenia followed by leucopenia must be subjected to bone marrow examination. We submit that bone marrow examination may be performed in chronic bicytopenia cases even if there is only mild anemia, and a comprehensive interdisciplinary approach inclusive of flowcytometry, molecular genetic analysis must be adopted so that even the mildest possibility of hematological malignancy is not missed.