Etiological causes of pancytopenia: A report of 137 cases

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.

Spectrum of Pancytopenia in Adults Attending a Clinical Hematology Department: A Four-Year Experience From a Tertiary Care Center of Western India

Background

Pancytopenia is a common hematological condition encountered in clinical practice. Because there is a wide variation in causes of pancytopenia even in different populations of the same geographical region, identifying the pattern of underlying etiologies is crucial for proper management. This study was conducted to evaluate the clinico-hematological profile and different etiologies of pancytopenia among adults presenting to a clinical hematology department at a tertiary care hospital of Western India.

Methodology

This observational study was conducted over a period of four years on 546 adult patients aged 18-93 years presenting with pancytopenia. After obtaining a detailed clinical history and physical examination, all participants were subjected to relevant investigations including bone marrow examination.

Results

A slight male preponderance was observed, and the most common age group (24%) was 21-30 years. Pallor was the most common clinical feature, followed by generalized weakness and fever. The most common cause of pancytopenia was acute leukemia (17.9%), followed by megaloblastic anemia (15.4%), aplastic anemia (11.0%), hypersplenism (7.8%), multiple myeloma (6.6%), and myelodysplastic syndrome (5.3%).

Conclusions

Acute leukemia was observed to be the most common cause of pancytopenia in this study, which is in contrast to various other studies from India conducted in different departments. Identification of etiologies of pancytopenia among patients attending hematology departments in various regions is expected to be useful in formulating diagnostic algorithms and management strategies, which can help clinicians to better manage such patients.

Splenomegaly in a Patient with a History of Pernicious Anemia; the Potential Therapeutic Effects of B12 Therapy

Splenomegaly is manifested by a variety of etiologies, one of which is macrocytic anemia. Macrocytic anemia has multiple causes in itself that include; folate (Vitamin B9) and Cobalamin (vitamin B12) deficiencies. In this case report, we present a patient with a history of pancytopenia, macrocytic anemia and vitamin B12 deficiency, who underwent a splenectomy. The differential diagnoses for the cause of the patient's splenomegaly included: lymphoma, infiltrative disease, and idiopathic splenomegaly. The pathology report from the splenectomy did not reveal any evidence of lymphoma or infiltrative disease, however, it did mention vascular congestion of the spleen. In theory, vascular congestion, due to extramedullary hematopoiesis in the spleen or sequestration of blood cell lineages, could lead to pancytopenia. In prior visits to the hospital this patient was diagnosed with: splenomegaly, and macrocytic anemia due to pernicious anemia. A splenectomy puts one at increased risk for infection by encapsulated organisms, and is to be avoided if possible. There are few case reports and studies that show vitamin B12 therapy can potentially cause a reversal in the splenomegaly as well as a reversal in the pancytopenia and macrocytic anemia. We hope to show that the least invasive treatment for vitamin B12, vitamin therapy, can be of use and effective.

Hemorrhagic manifestation in different etiologies of pancytopenia: A prospective, cross-sectional study

Background

Pancytopenia is a triage of anemia, leukopenia, and thrombocytopenia. The etiology causing pancytopenia varies depending upon factors such as age, sex, occupation, and geographical distribution. Unfortunately, the major treatises of hematology have not given emphasis on the hemorrhagic manifestation of different etiologies causing pancytopenia.

Objective

This observational study was carried out with the aim to identify hemorrhagic manifestation in patients with pancytopenia in eastern India.

Design

This study was conducted over a period of two years at the Department of Medicine of a tertiary care teaching institute in eastern India. All the patients with features of anemia, thrombocytopenia, or leukopenia were screened for pancytopenia and a total of 214 cases were selected. Patients were divided into two groups as patients with age more than 14 years constitute group one and the patients less than 14 years constitute the second group. A detailed physical examination, hematological, and biochemical investigation was done to ascertain the hemorrhagic manifestations in pancytopenia patients.

Results

In the groups, the most common cause of hemorrhagic manifestation in patients with pancytopenia was aplastic anemic, leukemia, myelodysplastic syndrome, and myelofibrosis. No bleeding manifestation was seen in patients with megaloblastic anemia, kala-azar, hypersplenism, and other causes of pancytopenia.

Conclusions

Patients with pancytopenia caused by aplastic anemia, acute leukemia, and myelodysplastic syndrome have more chances of bleeding manifestation as compared with pancytopenia caused by megaloblastic anemia, kala-azar, or hypersplenism.

Etiology and clinico-hematological profile of pancytopenia: experience of a Mexican Tertiary Care Center and review of the literature

BACKGROUND

Pancytopenia is a frequent entity in clinical practice as a feature of a myriad of conditions, ranging from benign to malignant diseases. Since the cause of pancytopenia depends on environmental factors, it is important to know the common etiologies of pancytopenia, however, few studies address this.

OBJECTIVES

To identify the etiology of pancytopenia in our population and compare them with what is reported elsewhere.

METHODS

We conducted an observational study of patients with pancytopenia in a Mexican Tertiary Care Center. Clinical, hematological and bone marrow studies were performed in all patients.

RESULTS

Of 109 cases included, the mean age at diagnosis was 49.4 years, with a slightly higher female incidence (53.2%). The most common causes of pancytopenia were: MDS (20.2%), megaloblastic anemia (18.3%) and AML (12.8%).

DISCUSSION

We found a complex picture of pancytopenia in Mexico and compared it with what is reported elsewhere in the literature.

CONCLUSION

The sociocultural context in which the patients develop helps narrowing the possible etiology of pancytopenia, and therefore hasten the diagnostic process. Of all the studies available, bone marrow aspiration seems the most useful.