Pancytopenia: Etiological Patterns In 50 Cases Admitted In General Medical Wards

Abstract

To determine the frequency and to identify the various causes of pancytopenia in patients admitted in General Medical Wards. Methods: We conducted a descriptive cross sectional study on fifty patients of pancytopenia admitted in medical wards of Liaquat University Hospital, Jamshoro / Hyderabad from 1st Mar’14 - 30th Sep'14. Out of 50 patients, 33 were males and 17 were females. Patients on cancer chemotherapy, those with a history of recent blood transfusion and those refusing bone marrow examination was not included. Medical History, physical examination and hematological factors at presentation were documented. Hematological summary comprised of hemoglobin level, differential and total leucocytes count, platelet count, reticulocyte count, peripheral smear and bone marrow aspiration/biopsy. The data was analyzed on SPSS version 18. Results: A total of 50 patients with mean age of 37.02 years (± 8.64 SD) were included in the study. Throughout the research period, in a total of 4800 admissions in medical wards, 182 had Pancytopenia on investigation of patient’s peripheral blood smear (3. 79%). Those out of 182 subjects suffering from pancytopenia, fifty randomly selected patients were included in the study. Cause of Pancytopenia was identified in 48 cases on the basis of examination of their bone marrow, while 02 cases remained undiagnosed. Megaloblastic anemia came out to be the most common diagnosis (n=17). Hypersplenism due to portal hypertension was the second most common diagnosis (n= 07). Aplastic anemia (n=5), Acute Lymphoblastic leukemia (n=5), Acute Myeloid Leukemia (n=4), Sepsis (n=3) and Myelodysplasia (n=2) were other important causes. Systemic Lupus Erythromatosis (SLE), falciparum malaria, Hodgkin’s disease, multiple myeloma were noted one in each case. Viral hemmohagic fever was suspected in one patient. The most frequent clinical presentations were fatigue, pallor, fever, petechial hemorrhages, visceromegaly, nose bleeding and GIT (gastrointestinal tract) bleeding. Conclusion: Pancytopenia is relatively a frequent problem in general medical wards. A thorough assessment is necessary to find out the underlying cause. Megaloblastic anemia, Hypersplenism, Aplastic anemia and acute leukemias were the most common causes. Bone marrow aspiration and trephine biopsy are found to be useful tools in evaluation of Pancytopenia.