A Clinico: Hematological study of pancytopenia

Pancytopenia is a significant clinical and hematological condition frequently observed in health care settings. It is marked by decrease in all three blood cell types: RBC, WBC and platelets. The underlying causes of pancytopenia vary across different populations, influenced by factors such as age, nutritional status, climate, and the prevalence of infections. These causes range from temporary bone marrow suppression resulting from viral infections to marrow infiltration by severe and potentially fatal malignancies. This study aims to correlate peripheral blood film observation and bone marrow evaluations in individuals exhibiting pancytopenia and to examine blood related parameters in relation to clinical observation in order to distinguish its underlying factors. Blood samples (2 mL) were collected via venipuncture under sterile conditions in tubes containing EDTA as an anticoagulant. The whole blood sample was analyzed using the Sysmex XN 550/350 automated five-part diffrential. Bone marrow aspiration and trephine biopsy were performed based on clinical indications, and standard procedures were followed for bone marrow processing and staining. Leishman’s and Giemsa stains were used for microscopic evaluation. Megaloblastic anemia emerged as the leading contributor to pancytopenia in our study (34.18%), with aplastic anemia (15.19%) ranking second and iron deficiency anemia (11.39%) coming next. Other identified causes included lymphoproliferative disorders, plasma cell disorders, acute leukemia, mixed nutritional deficiency anemia, marrow fibrosis, myelodysplastic syndrome, Gaucher’s disease, malaria infection, parvovirus infection, and mycobacteriosis. In four cases (5.06%), no definitive cause could be determined. Our findings indicate that pancytopenia is most commonly caused by megaloblastic anemia, with aplastic anemia being the second most frequent caus. This underscores the significant prevalence of nutritional anemia in our area. However, rare conditions such as plasma cell disorders, malaria infection, and parvovirus infection were also identified. Notably, our study reported two cases of mycobacteriosis and one case of Gaucher’s disease.