Publication:

Etiological profile of pancytopenia in a tertiary care hospital

Background As the severity of pancytopenia and the underlying pathology determines the management and prognosis of these patients, identifying the correct etiopathology in a given case is crucial and helps in implementing timely and appropriate treatment.The objective of the study was to determine the etiological profile of pancytopenia.

Methods The present study included 44 patients with pancytopenia comprising of all ages and both sex. All cases were analyzed with respect to age, sex, clinical features at presentation, hemogram, peripheral smear, serum B12, plasma Folate, serum ferritin and bone marrow aspiration and etiological profile of pancytopenia was ascertained. Whether critical analysis of peripheral smear provides clue to the underlying pathology and how frequently bone marrow aspiration yields the diagnosis were also studied.

Results Megaloblastic anemia was the most common cause of pancytopenia in this study (54.5%). Malignant and premalignant conditions (20.5%) were the second commonest cause of pancytopenia. Among 24 patients of megaloblastic anemia, 13 patients (54.16%) had macrocytic picture on peripheral smear suggestive of uncomplicated megaloblastic anemia. Of the 24 patients of megaloblastic anemia, 22 patients (91.66%) had low serum B12 levels. The distribution of cellularity, megakaryopoiesis, erythropoiesis, granulopoiesis on bone marrow aspiration differed significantly across various causes of pancytopenia (p-value <0.001).

Conclusions Megaloblastic anemia should be considered first when managing a patient of pancytopenia and peripheral smear should be carefully examined for features of megaloblastic anemia.