A Prospective and Retrospective Study of Bone Marrow in Patients with Pancytopenia– A Study of 150 Cases

BACKGROUND : The bone marrow is widely distributed organ and is the principle site for blood cells forma?on. The broad spectrum of disorders affects the marrow primarily or secondarily with presenta?on of peripheral pancytopenia. Hence, bone marrow examina?on is extremely helpful in evalua?on of pancytopenia. This study emphasizes the different causes of pancytopenia and bone marrow morphology in cases of pancytopenia. MATERIALS & METHODS: The present study is a retrospec?ve and prospec?ve study done in the department of Pathology, for a period of two years. All the relevant history, clinical details, radiological details, and biochemistry parameters were considered. RESULTS: Out of 150 cases,96 were males and 54 were females. Majority of the pa?ents were in the age group of 41-60 years (54%) amongst whom Megaloblas?c anaemia was the most important cause of pancytopenia. CONCLUSION: Bone marrow aspira?on is rela?vely a very safe invasive procedure and primarily permits cytological assessment since the underlying pathology determines the management and prognosis of the pa?ents.

Bone Marrow Aspiration Findings in Hematological Disorders in Children

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.

Aetiology of pancytopenia: Experience of a South African tertiary academic centre

Background: Pancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis. Objective: This study aimed to determine the aetiology of pancytopenia in a South African population.Methods: A retrospective observational study of adult patients presenting with pancytopenia at Tygerberg Academic Hospital, South Africa, from January 2016 to December 2017 was performed. Data on pancytopenia cases were obtained from the laboratory information system and utilised to determine the causes of pancytopenia. Results: A total of 673 cases of pancytopenia were identified. The most common causes of pancytopenia were chemoradiation therapy (25%), sepsis (18%), haematological malignancy (9%), advanced HIV (7%), and megaloblastic anaemia (6%). The diagnostic yield of bone marrow examinations (BME) was 57% (n = 52/91). The aetiology of pancytopenia differed according to age, with malignancy being a more common cause of pancytopenia among the elderly. Conclusion: Several easily recognisable and treatable conditions can manifest as pancytopenia. Prompt management of such conditions, notably sepsis and megaloblastic anaemia, can result in the resolution of the cytopenias and negate the need for a BME. However, haematological malignancy and unexplained pancytopenia strongly rely on a BME to establish a diagnosis. Pancytopenia investigations, when guided by appropriate clinic-laboratory findings, can promptly identify the underlying aetiology, while also identifying cases where an expedited BME is required. This is valuable in resource-conscious medicine

Study of etiological spectrum and clinical profile of patients admitted in tertiary care hospital of South Gujarat, India

Background: Pancytopenia is defined as reduction of all three formed elements of blood below normal reference range. The symptoms are fatigue, fever, dizziness and weight loss. Evaluation was done using complete hemogram and peripheral smear. The presenting marrow biopsy is most useful and accurate in evaluation of pancytopenia.Methods: Two ml of anticoagulated blood was collected for complete hemogram. The peripheral blood smear was stained with Leishman's stain and studied. Bone marrow biopsy and aspiration was done in all the patients to identify etiology.Results: Predominance was seen in the age group of 31-60 years. Most common cause of pancytopenia was megaloblastic anaemia in this study compared to other studies all over the world where most common cause was aplastic anaemia. This reflects higher prevalence of megaloblastic anaemia in the Indian subjects.Conclusions: A comprehensive clinical, haematological land bone marrow study of patients with pancytopenia usually helps in identification of the underlying cause.

Peripheral cytopenia in children: a hospital-based study

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.

A prospective clinico‑hematological study in 100 cases of Pancytopenia in a tertiary care teaching hospital

Background: Pancytopenia is encountered regularly in haematology practice, yet there exist only few published assessments of the frequencies of various aetiologies and this exhibit substantial geographic variation. Pancytopenia is a manifestation of many life- threatening diseases with a wide range of differential diagnosis. Haematological investigation forms the bedrock in the detection and management of patients with pancytopenia.Methods: This study is a prospective study conducted in the Institute of pathology and haematology, Madras medical college and Rajiv Gandhi Government General Hospital, Chennai during the period from August 2015 to August 2016 on 100 cases. Case selection is based on clinical features and supported by laboratory evidence. Peripheral smear was obtained and stained by Leishman stain for all cases and examined in detail. Bone marrow aspiration /biopsy was subsequently carried out under aseptic precautions.Results: Among the 100 cases studied, age of the patients ranged from 13 to 80 years with a slight male predominance. Most of the patients presented with generalized weakness and fever. The commonest cause for pancytopenia was aplastic anaemia followed by megaloblastic anaemia. The other causes include acute myeloid leukaemia, myelodysplastic syndrome, myelofibrosis, multiple myeloma, malarial parasite, miliary tuberculosis and osteopetrosis.Conclusions: Pancytopenia can be diagnosed, and its etiological profile can be ascertained with the help of detailed clinical history, meticulous physical examination and haematological investigations. Every attempt should be done to establish the underlying cause so that treatable conditions are diagnosed without delay and prognosis is improved.

Study of serum lactate dehydrogenase level as diagnostic and prognostic indicator of megaloblastic anemia

Background: Megaloblastic anaemia is the hematologic manifestation of faulty proliferation of blood cell precursors. The present study was done to facilitate the diagnosis prior to performing any bone marrow aspirate by estimation of the value of serum LDH in the diagnosis of megaloblastic anaemia.Methods: The cases were selected from patients attended the OPD and admitted in Sanjay Gandhi Memorial Hospital & Gandhi Memorial Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh. Following investigations were then done to classify anaemia and to establish the diagnosis of megaloblastic anaemia like Haemoglobin estimation by cyanmethaemoglobin method, PCV, RBC count and absolute values, general blood picture, reticulocyte count, bone marrow examination and serum LDH estimation before and after treatment.Results: Of the 100 cases, 50 cases (50%) of the cases were microcytic hypochromic anaemia. 15 cases (15%) were normocytic normochromic anaemia; 35 cases (35%) were macrocytic anaemia on the basis of general blood picture and absolute values. The incidence of megaloblastic anaemia in Indian adults was 20%. Maximum number of cases (90%) of the cases had serum LDH level of more than 1000 U/L. Range of serum LDH level was 520 U/L to 4520 U/L. Thus, there was 2 to 20-fold of highest reference value (240 U/L at37 C) rise in serum LDH level in megaloblastic anaemia.Conclusions: Megaloblasatic anaemia is not uncommon in Indian adults and serum LDH levels provide an important means of diagnosis. It is a non-invasive procedure, safe, and does not require any expertise.

Pancytopenia: the perspective from Western Gujarat, India

Background: Pancytopenia is one of the common laboratory findings in patients presenting to us with varied clinical presentations. Risks of untreated Pancytopenia are high causing anxiety to treating doctors and patients alike. It also involves long list of investigations including a very painful marrow biopsy, life-threatening complications and treatment involves multiple blood component therapy. A total of 101 cases of pancytopenia over a period of 1 year were analysed retrospectively to find i) commonest presenting symptoms ii) commonest cause of pancytopenia, response to treatment iii) Depending on the cause, to consider if any measures can be taken for preventionMethods: Cross sectional study of 101 admitted patients of Pancytopenia on the basis of information extracted from the case sheets. The data was analyzed and presented as frequencies and Percentages.Results: Out of 101 cases analysed, 53 (52.47%) were females 48 (47.52%) patients males. Fatigue 74 patients (73.2%) was the commonest presenting symptom followed by fever 33 (32.6%), breathlessness 13 (12.87%) and bleeding 4(3.8%). Vitamin B12 deficiency 58 (57.6%) patients showed and was the commonest cause of pancytopenia. Infections in 24 (23.7%) like malaria16 (15.6%), dengue 5 (4.96%), PLHA 1(0.96%) and hepatitis B 2 (1.96%) was the second common cause in present study. Recovery of pancytopenia was prompt in Malaria Dengue. HIV, Hepatitis B viral infection showed persistent pancytopenia with hypoplastic marrow. Chronic liver disease portal hypertension splenomegaly accounted for 9 (8.9%) patients. Drug induced marrow suppression due to ongoing treatment for underling disease resulted in pancytopenia in 4 (3.96%) patients. Aplastic anaemia in3 (2.9%), myelodysplastic syndrome 2 (1.9%) and acute leukaemia 1 (0.96%) were the less common causes.Conclusions: Commonest symptom on presentation were related more to anaemia than to neutropenia and thrombocytopenia. megaloblastic anaemia due to Vitamin B12 deficiency was the leading reversible cause of pancytopenia in present study followed by infections like Malaria Dengue. Gujarat, India being predominantly vegetarian state, local dietary habits are thought to be responsible for inadequate B12 daily consumption, hence we suggest fortifying the daily diet with B12 supplementation at a larger scale just like iodisation of salt to counter iodine deficiency.

Imerslund-Grasbeck Syndrome: A Case Report.

Imerslund- Grasbeck syndrome is a rare autosomal recessive disorder due to selective malabsorption of Vitamin B12 at the level of cobalamin-intrinsic factor receptor mutation in the terminal ileum resulting in megaloblastic anaemia with proteinuria. Early detection of this rare disorder would enable screening and genetic counselling for asymptomatic family members.

Malarial anaemia and nitric oxide induced megaloblastic anaemia: A review on the causes of malarial anaemia.

Direct destruction and ineffective erythropoesis does not adequately explain the cause of anaemia in malaria. It is possible that there are more other mechanisms involved besides the causes described till date in malarial anaemia. The effect of NO on erythropoesis and a major haematological abnormality (microcytic/normocytic/megaloblastic picture) can significantly be observed on repeated exposure. In addition, NO can inhibit the enzyme methionine synthase so functional vit B12 deficiency state may occur which can lead to megaloblastic anaemia. This review will focus on causation of malarial anaemia and nitric oxide induced megaloblastic anaemia.