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Background: Primary objective was to study bone marrow aspiration(BMA) findings in hematological disorders in children with secondary objective to find correlation between peripheral blood film (PBF) findings with BMA.Material & Methods:It was observational and cross-sectional study conducted on 65 children in age group of 1-18 yrs admitted to Pediatrics Department of Government Medical College, Patiala over period of 1 yr. Inclusion criteria was based on clinical and laboratory parameters. Children were of anaemia, leucopenia and pancytopenia. Complete hemogram, reticulocyte count, PBF smear and bone marrow aspiration were done. The data was analyzed using IBM Statistical Packages for Social Sciences SPSS software version 22.Results:The mean age of study population was 10.39�29yrs. 93.8% children presented with pallor followed by fever in 84.6% and lethargy in 66.2%. 62 children were severely anaemic, 33 had bicytopenia, 23 children had pancytopenia. Bone marrow was hypercellular in 59 (90.8%) children. 40 (61.5%) children had megaloblastic anaemia on BMA followed by dimorphic anaemia in 8, Idiopathic thrombocytopenic purpura in 6 children. 4 children each had Megaloblastic anaemia with gelatinous transformation and micronormoblastic anaemia. 2 children had acute lymphatic leukemia and one had aplastic anaemia. The predominant PBF was dimorphic in 30 children, out of whom 22 had megaloblastic anaemia and 8 had dimorphic anaemia on BMA. Conclusions:Bone marrow was megaloblastic in majority (61.5%) of children. There was no significant association found between PBF findings and bone marrow diagnosis.
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Background: Peripheral cytopenia with its ramifications as pancytopenia and bicytopenia is a common hematological phenomenon in children. Its etiology ranging from benign self-limiting illness to severe life-threatening conditions decide the management and prognosis in these children. This study aims to describe the clinical, haematological and etiological profile of peripheral blood cytopenia in children of Rohilkhand region.Methods: A hospital based prospective observational study conducted in the Pediatric ward of a teaching hospital over a period of 30 months. All children between age 6 months to 14 years with bicytopenia and pancytopenia on hemogram were included. Detailed history, clinical examination, haematological tests followed by bone marrow aspiration wherever indicated was performed. Additional tests like parasitological and sepsis work up was undertaken on case to case basis, to ascertain the cause of cytopenia.Results: Bicytopenia was more common than pancytopenia (61.2% vs. 38.8%) The most common age group observed was 10-14 years. Normocytic normochromic blood picture was seen in all cases of cytopenia while macrocytic normochromic blood picture had statistically significant association with pancytopenia. Fever was the commonest symptom, while pallor was the commonest sign followed by hepatosplenomegaly. Most common etiology in bicytopenia was infective (68%) while pancytopenia reported equal incidence of infective (50%) and non-infective causes. Malaria was the commonest infective cause of bicytopenia (46.3%) and pancytopenia (27%). Children with bicytopenia had higher incidence of malignancy (22% vs. 7.7%) and lesser incidence of nutritional causes (7.3% vs. 27%), and aplastic anemia (2.4% vs. 15.4%) as compared to pancytopenia.Conclusions: Clinical assessment coupled with haematological tests plays a pivotal role in ascertaining the cause of cytopenia in children. As the etiologies are varied, their knowledge and distribution unique to a particular region may help in better management and outcome.
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The epidemic of Dengue is steadily increasing in more than 100 endemic countries. During critical phase, of this disease, shock with organ dysfunction and severe bleeding, can occur. Rarely, it can be further complicated by Hemophagocytic lymphohistiocytosis (HLH), which results from aberrant activation of immune mechanism. HLH is a rare, frequently fatal if untreated condition. It challenging to diagnose because initial symptoms mimic other conditions which are more common. Dengue induced Secondary Hemophagocytic lymphohistiocytosis (HLH), may be responsible for severe form of Dengue with adverse outcomes. We describe a case of an infant, with Dengue fever whose clinical situation deteriorated after being stable during initial phases of illness due to development of Secondary Hemophagocytic lymphohistiocytosis (HLH). The child had persistent fever, anemia, hepatomegaly with deranged coagulation which directed towards diagnosis of Secondary Hemophagocytic lymphohistiocytosis (HLH). We discuss the features of our case and its management to sensitize the clinicians to consider this condition in patients with severe Dengue fever.
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The common causes of bicytopenia or pancytopenia include either marrow suppression or marrow infiltration. It may be due to aplastic anemia, megaloblastic anemia or hematological malignancies. The present study was done to find the clinico-aetiological profile of bicytopenia & pancytopenia among pediatric patients. Methods: The present hospital based cross-sectional study was done on children suffering from bicytopenia or pancytopenia. Detailed clinical history, thorough physical examination and hematological tests were done. Appropriate statistical calculations for summarization of data were done. Results: Bicytopenia was seen in 58.2% and pancytopenia in 41.8% patients. Megaloblastic anemia (43.6%), infection (23.6%), aplastic anemia (14.5%) and leukemia (10.9%) were the aetiological factors. Patients presented with pallor (85.5%), fever (76.4%), petechial haemorrhage (43.6%), hepatomegaly (38.2%), splenomegaly (23.6%), anorexia (21.8%) and lymphadenopathy (18.2%). Conclusion: Non-malignant causes were responsible in majority of cases (89.9%) and can be treated.
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Resumen: Introducción: El síndrome de Evans se caracteriza por la disminución de, al menos, dos líneas celulares en ausencia de otros diagnósticos. Anteriormente, se definía como el desarrollo simultáneo o secuencial de trombocitopenia inmune primaria y anemia hemolítica autoinmune sin etiología específica. Se ha reportado una incidencia del 37% y una mortalidad del 10% de este síndrome. Casos clínicos: Se presenta la información clínica y la evolución del síndrome de Evans en dos pacientes lactantes que inicialmente fueron diagnosticados con trombocitopenia inmune primaria. El diagnóstico clínico se apoyó con estudios de gabinete, donde se corroboraron las alteraciones hematológicas. El manejo se realizó con esteroides e inmunoglobulina. Conclusiones: En el abordaje del paciente pediátrico con trombocitopenia se deben buscar alteraciones de otra línea celular. En los casos reportados se detectó la presencia de anemia hemolítica y monocitosis, por lo que se deben incluir estudios infecciosos e inmunológicos. El tratamiento de primera línea es con esteroides, y debe considerarse la administración de inmunoglobulina si existe trombocitopenia severa asociada, como se observó en estos casos.
Abstract: Background: Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome. Clinical cases: We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin. Conclusions: For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.
ABSTRACT
Background: The etiology of bicytopenia/pancytopenia varies widely in children, ranging from transient marrow viral suppression to marrow infiltration by fatal malignancy. Depending on the etiology, the clinical presentation can be with fever, pallor or infection. Knowing the exact etiology is important for specific treatment and prognostication. Aims: To evaluate the etiological and clinico-hematological profile in children with bicytopenia and pancytopenia. Materials and Methods: A review of bicytopenic and pancytopenic children referred for bone marrow examination from January 2007 to December 2008 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Results and Conclusion: During the study period, a total of 990 children were referred for bone marrow examination for different indications. Of these, 571 (57.7%) had either pancytopenia (17.7%) or bicytopenia (40%). Commonest form of bicytopenia was anemia and thrombocytopenia seen in 77.5% cases, followed by anemia and leukopenia in 17.3% and leukopenia and thrombocytopenia in 5.5% cases. Most common etiology was acute leukemia (66.9%) in bicytopenic children and aplastic anemia (33.8%) in pancytopenic children. Children with bicytopenia had a higher incidence of underlying malignancy (69.5% vs. 26.6%), splenomegaly (60.5% vs. 37.4%), lymphadenopathy (41.8% vs. 15.1%) and circulating blasts (64.6% vs. 20.1%) and a lower incidence of bleeding manifestations (12.1% vs. 26.6%) as compared to children with pancytopenia.