Clinicopathological study of new onset pancytopenia: An experience of largest study from a tertiary care center of western India

Abstract

Background: Pancytopenia is characterized by decreased hemoglobin (adult males <13 g/dl, pregnant females <10 g/dl, nonpregnant females and children <11 g/dl), total leukocyte count (<4 × 109/L), and platelet count (<100 × 109/L). Depending on the severity, patients can present with varied symptoms. Vast majority of conditions causing pancytopenia are known. Hence, a systematic approach is a mandatory requirement to identify the cause of pancytopenia for appropriate management. Aim: Clinicopathological study of new onset pancytopenia and to determine the frequency of different etiologies causing pancytopenia. Materials and Methods: A prospective study of 451 consecutive cases who had pancytopenia and presented in outpatient or emergency room of a tertiary care center of Western India, from July 2017 to September 2019. The clinical data of the patients were obtained and hematological investigations were analyzed in the hematopathology section of the pathology department. Bone marrow (BM) aspirates and biopsies were performed in 355 cases. Data were analyzed using SPSS software. Results: Patients age ranged from 6 months to 84 years with mean standard deviation of 45.89 ± 19.21 years. Overall male to female ratio was 1.87:1. Hematolymphoid malignancy was the most common cause (n = 137, 30.37%) followed by nutritional anemia (n = 97, 21.5%), infections (n = 68, 15.07%), BM failure (n = 66, 14.63%), hypersplenism (n = 55, 12.19%), and autoimmune disorder (n = 11, 2.44%). Conclusion: Pancytopenia is a common hematological entity with the multifactorial etiologies. It can present as a life-threatening condition or can be merely transient. Hematolymphoid malignancy was found to be the most common underlying cause in our study. An accurate etiological break will further assist in appropriate management of these patients.

Keywords

• bone marrow failure
• hematolymphoid malignancy
• hypersplenism
• nutritional anemia
• pancytopenia