Clinicopathological Diversity of Pancytopenia: A Series of 400 Cases

Abstract

Introduction: Pancytopenia is characterised by decreased haemoglobin, Packed Cell Volume (PCV), Total Leukocyte Count (TLC) and Platelet Count (PC). Variety of haematological disorders can present with pancytopenia and hence, it has an extensive differential diagnosis. The clinical presentation is based on the severity of pancytopenia as well as its aetiology that warrants a systematic approach to identify the cause of pancytopenia. Aim: To evaluate the clinicopathological characteristics of various causes of pancytopenia. Materials and Methods: A total of 400 cases presenting with pancytopenia were clinically assessed, and the haematological investigations were collected from the haematology unit of Department of Pathology, from January 2010 to December 2016. The clinical data of the patients was obtained and the haematological findings were analysed. Bone marrow aspiration (200/400 cases) and biopsy (77/400 cases) were evaluated. Data was analysed using SPSS 22.0 version. The test of significance was performed by chi-square test. A p-value <0.05 was considered of statistical significant. Results: Among the 400 cases, malaria was the most common cause for pancytopenia (n=108, 27%), followed by megaloblastic anaemia (n=93, 23.25%). Other causes included hypersplenism, liver disease, retroviral disease, acute leukaemia, hypoplastic marrow, sepsis, myelodysplastic syndrome, lymphoma, myelofibrosis, and certain infections. Rare causes such as fanconi anaemia, tuberculosis and mucolipidosis were also encountered. The most common symptom with which the patients presented was weakness and easy fatigability (n=337, 84.3%) and pallor was the most common physical sign (n=400, 100%). Conclusion: Pancytopenia is a commonly encountered entity in outpatient clinics which has got a wide variety of differential diagnosis. In certain diseases, pancytopenia is transient and uncomplicated; however, it can be a presenting feature of a life threatening disease as well. Therefore, a systematic approach in evaluating the underlying cause of pancytopenia is essential to plan and implement the timely intervention.

Keywords

• bone marrow
• cytopenia
• malaria
• megaloblastic anaemia