Etiology of Pancytopenia in Tabriz Shahid Ghazi Hospital: A Cross-sectional Study in Iran
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Keywords

Pancytopenia
Leukemia
Anemia
Bone marrow
Blood cells

DOI

10.26689/par.v8i4.7902

Submitted : 2024-07-10
Accepted : 2024-07-25
Published : 2024-08-09

Abstract

Objective: Pancytopenia is characterized by a reduction in all three types of blood cells: erythrocytes, leukocytes, and platelets. Pancytopenia is caused by a wide range of diseases, leading to diagnostic conundrums. These causes can range from drug reactions to life-threatening diseases such as aplastic anemia and leukemia. This study aims to investigate the causes of pancytopenia, specifically focusing on age and gender differences among patients. Methods: This cross-sectional study includes patients of all ages diagnosed with pancytopenia, as indicated by a CBC/H1 showing a WBC count less than 4,000/µL, platelet count less than 150,000/µL, and hemoglobin levels below 12 g/dL in women and less than 13 g/dL in men. The study only included patients with pancytopenia who underwent bone marrow examination and were not subjected to chemotherapy or radiation therapy. Results: A total of 133 patients with pancytopenia were included in the study. The average age was 47.35 ± 17.62 years old, with 66% of the participants being male and 34% being female. Acute leukemia, specifically acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL), was identified as the primary cause of pancytopenia, accounting for 31.5% of cases. Megaloblastic anemia was the second most common cause, accounting for 30% of cases, followed by aplastic anemia at 7.5%. Conclusion: Pancytopenia, a condition marked by the decrease in both erythrocytes and leukocytes as well as thrombocytes, can arise from a myriad of causes. The main findings of this study revealed that megaloblastic anemia, acute myeloid leukemia (AML), and acute lymphoid leukemia (ALL) were the most common causes. Significantly, a considerable proportion of cases of pancytopenia can be attributed to acute leukemia. Hence, expeditious and accurate diagnosis is imperative and has the potential to save lives in such cases.

References

Chiravuri S, De Jesus O, 2023, Pancytopenia. StatPearls Publishing, Treasure Island.

Young NS, Abkowitz JL, Luzzatto L, et al., 2000, New Insights into the Pathophysiology of Acquired Cytopenias. ASH Education Program Book, 2000(1):18–38.

Pascutti MF, Erkelens MN, Nolte MA, et al., 2016, Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Frontiers in Immunology, 7:364.

Marks PW, 2013, Hematologic Manifestations of Liver Disease. Seminars in Hematology, 50(3):216–221.

Risitano AM, Maciejewski JP, Selleri C, et al., 2007, Function and Malfunction of Hematopoietic Stem Cells in Primary Bone Marrow Failure Syndromes. Current Stem Cell Research & Therapy, 2(1):39–52.

Neumann E, 1868, Uber die Bedeutung des Knochenmarks fur die Blutbildung. Zentralblatt für die medizinischen Wissenschaften, 44: 122.

Bizzozero G, 1868, Sulla Funzione Ematopoetica del Midollo Delle Ossa. Zentralbl Med Wissensch, 6(1868): 885.

Patel F, Panjwani S, Lakhani K, et al., 2017, A Study of Clinical Profile of 50 Patients Having Pancytopenia in SIRT General Hospital, Bahvnagar. European Journal of Pharmaceutical and Medical Research, 4(66):349–377.

Ryan DH, Cohen HJ, 2002, Bone Marrow Aspiration and Morphology. Hematology: Basic Principles and Practice, 2460–8.

Jella R, Jella V, 2016, Clinico-Hematological Analysis of Pancytopenia. International Journal of Advances in Medicine, 3(2):176–9.

Khan TA, Khan IA, Mahmood K, et al., 2013, Clinicohaematological Spectrum of Pancytopenia in a Tertiary Care Hospital. Journal of Postgraduate Medical Institute (Peshawar-Pakistan), 27(2):143–147.

Mudenge B, Savage DG, Allen RH, et al., 1999, Pancytopenia in Zimbabwe. The American Journal of the Medical Sciences, 317(1):22–32.

Valent P, 2012, Low Blood Counts: Immune-Mediated, Idiopathic, or Myelodysplasia. ASH Education Program Book, 2012(1):485–491.

Azaad MA, Li Y, Zhang Q, et al., 2015, Detection of Pancytopenia Associated with Clinical Manifestation and Their Final Diagnosis. Open Journal of Blood Diseases, 24(5):17–30.

Cashen AF, Van Tine B, 2012, Cause of Pancytopenia: The Washington Manual of Hematology and Oncology Subspecialty Consult. Lippincott Williams & Wilkins, 3rd ed, London, 81–90.

Kasper D, Fauci A, Hauser S, et al., 2018, Harrison’s Principles of Internal Medicine. McGraw-Hill Professional Publishing. Chapter 98: Bone Marrow Failure Syndromes Including Aplastic Anemia and Myelodysplasia, 20th ed, New York, 3000P.

Tilak V, Jain R, 1999, Pancytopenia: A Clinico-Hematologic Analysis of 77 Cases. Indian Journal of Pathology & Microbiology, 42(4):399–404.

Heimpel H, 1987, Incidence of Aplastic Anemia: The Relevance of Diagnostic Criteria. Blood, 70(6):1718–1721.

Gupta M, Chandna A, Kumar S, et al., 2016, Clinicohematological Profile of Pancytopenia: A Study from a Tertiary Care Hospital. Dicle Tip Dergisi, 43(1):5–11.

Bunch C, 1995, Bone Marrow Failure. Medical International, 10:495–499.

Imbert M, Scoazec JY, Mary JY, et al., 1989, Adult Patients Presenting with Pancytopenia: A Reappraisal of Underlying Pathology and Diagnostic Procedures in 213 Cases. Hematologic Pathology, 3(4):159–167.

Keisu M, Öst Å, 1990, Diagnoses in Patients with Severe Pancytopenia Suspected of Having Aplastic Anemia. European Journal of Haematology, 45(1):11–14.

Karsing P, Kh A, Singh D, et al., 2018, Clinicopathological Spectrum of Pancytopenia in a Tertiary Care Center in Northern India. Recent Advances in Pathology & Laboratory Medicine, 4(3):9–13.

Khunger JM, Arulselvi S, Sharma U, et al., 2002, Pancytopenia: A Clinico-Haematological Study of 200 Cases. Indian Journal of Pathology & Microbiology, 45(3):375–379.

Khodke K, Marwash S, Buxi G, et al., 2001, Bone Marrow Examination in Cases of Pancytopenia. Journal of the Indian Academy of Clinical Medicine, 2:55–59.

Kumar R, Kalra SP, Kumar H, et al., 2001, Pancytopenia: A Six-Year Study. The Journal of the Association of Physicians of India, 49:1078–1081.

Gayathri BN, Rao KS, 2011, Pancytopenia: A Clinico-Hematological Study. Journal of Laboratory Physicians, 3(1):15–20.

Varma N, Dash S, 1992, A Reappraisal of Underlying Pathology in Adult Patients Presenting with Pancytopenia. Tropical and Geographical Medicine, 44(4):322–327.

Makheja KD, Maheshwari BK, Arain S, et al., 2013, The Common Causes Leading to Pancytopenia in Patients Presenting to Tertiary Care Hospital. Pakistan Journal of Medical Sciences, 29(5):1108–1111.

Agarwal R, Bharat V, Gupta BK, et al., 2015, Clinical and Hematological Profile of Pancytopenia. International Journal of Clinical Biochemistry & Research, 2(1):48–53.

Santra G, Das BK, 2010, A Cross-Sectional Study of the Clinical Profile and Aetiological Spectrum of Pancytopenia in a Tertiary Care Centre. Singapore Medical Journal, 51(10):806–812.

Jalaee-Khoo H, Keihani M, 2006, The Causes of Pancytopenia from 1373 to 1381 Who Were Admitted to Army 501 Hospital. Tehran University of Medical Science Journal, 64(2):91–94.