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Changing Trends in Etiology of Pancytopenia-our Experience

Introduction: Pancytopenia is actually a triad of laboratory findings comprising of anemia, leucopenia and thrombocytopenia due to reduction of these elements below the reference value. Usually pancytopenia occurs in serious and life threatening illnesses including malignancy but is not uncommon in benign conditions like drug induced bone marrow hypoplasia, megaloblastic anemia etc. Management and the prognosis of these patients depend on the underlying etiology. So it is important to identify the correct etiology in all cases which is the cornerstone in implementation of appropriate management. The aim of this study was to assess the clinical profile of patients with pancytopenia and to determine the etiology along with comparing our findings with those of other similar studies. Material and methods: This is a prospective study of hundred cases of pancytopenia admitted to different medical wards of Tata Main Hospital, Jamshedpur a teaching institute and a secondary care hospital in Jharkhand, India over a period of twelve months (April 2014-March 2015). All adult patients of both sex with provisional diagnosis of pancytopenia was taken in to the study group the parameters being haemoglobin value less than 10 gm/dl, total leucocyte count less than 4000/cu mm and platelet count less than 100,000/cumm. Complete medical history was documented in all patients. Detailed general and systemic examinations were carried out. Total haematological work up was done including bone marrow aspiration and trephine biopsy. Other investigations like serum protein electrophoresis, ultrasonography of abdomen and pelvis etc were also carried out where ever indicated. The data was compiled and analyzed. Observation and Result: Out of 100 cases 56 cases were female and 44 were male. Age varied between 14-84 years. Most common symptoms in our series were nonspecific, weakness accounting to 70% of cases. Fever of varying degree was noted in 51%, breathlessness on exertion in 40% and 22% presented with complains of bodyache. Bleeding manifestations was observed in 9% of cases. 32% of patients had haemoglobin below 4 gm/dl, 36% had between 4-6 gm/dl and rest presented with haemoglobin above 6 gm/dl. Pancytopenia was due to megaloblastic anaemia in 44% of cases in our series where as 24% had dimorphic picture. 8% of cases were diagnosed to have myelodysplastic syndrome. Nine cases had aplasic anemia. Conclusion: Megaloblastic anaemia is the most common cause of pancytopenia in our series which is similar to studies conducted in other institutions except a few where aplastic anaemia was the commonest etiology. It is a rapidly corrective disorder and should not be missed and should be kept in mind as one of the commonest etiology of pancytopenia.

Author(s): Mohanty Bijaya, Singh Reetu, Prasad Satish