European Journal of Molecular & Clinical Medicine

Abstract

Background: Pancytopenia is a relatively common hematological entity characterized by the reduction of three formed elements of blood. It may be a manifestation of a wide variety of disorders, which primarily or secondarily affect the bone marrow. Hematological investigation plays an important part in the management of patients with pancytopenia and therefore needs a detailed study of bone marrow. We in the current study tried to evaluate the clinical presentations and hematological profile of cases with pancytopenia due to various causes.
Methods: A complete hematological workup was done which included hemoglobin estimation, RBC count, RBC indices (MCH, MCV, MCHC), WBC count, differential count, reticulocyte count, ESR, PCV, Platelet count, Bleeding time, clotting time and clot retraction test. Peripheral smear was stained by Leishman stain for all the cases. To determine the cause, this was done for every patient. The material was aspirated from the tibial tuberosity in infants under the age of two or the posterior iliac crest in adults using a Jemshidi needle.
Results: A total of n=40 cases were studied in this study. Megaloblastic anemia was commonest cause constituting 70.0% followed by aplastic anemia 17.5%, Malaria 5.0% subleukemic leukemia 2.5%, multiple myeloma 2.5%, and storage disorder 2.5%. In the study majority of megaloblastic erythropoiesis occurs in the hypercellular bone marrow. Gigantic megakaryocytes and giant band metamyelocytes were also seen. The majority of patients had reduced fat cells and hypercellular bone marrow 62.5%. 10% of cases had normocellular bone marrow. In all the cases there was erythroid hyperplasia with megaloblastic maturation.
Conclusion: when a patient presents with unexplained anemia, prolonged fever, and a tendency to bleed. The physical findings and peripheral blood picture provide valuable information in the work of cytopenic patients. The typical presentation in the peripheral blood picture will be anemia, presence of nucleated RBCs, and immature myeloid cells which may be suggestive of marrow infiltration of primary hematologic disorder.