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Etiological Study Of Pancytopenic Children

By: Dr. Syed Maaz Nadeem | Dr. Muti-ur-Rehman Khan.
Contributor(s): Dr. Aftab Ahmed Anjum | Dr. Asim Aslam.
Material type: materialTypeLabelBookPublisher: 2011Subject(s): Department of PathologyDDC classification: 1539,T Dissertation note: Pancytopenia is a hematological condition in which there is a decrease in all three cell lines of peripheral blood i.e. erythrocytes, leucocytes and platelets leading to anemia, leucopenia and thrombocytopenia. Complications of anemia, repeated infections and bleeding tendencies are sometimes horrifying and may result in death of individual. The present study was designed to analyze the underlying pathology, different clinico-haematological features and importance of bone marrow study in one hundred children presenting with pancytopenia. Present study was carried out in pediatric laboratory of Mayo Hospital, Lahore, Pakistan.. Detailed history was taken in all cases. Complete blood counts were done on an automated blood analyzer (Sysmex Kx-21). For counter check of total leucocyte count, differential leucocyte count and platelets, smears were also prepared and stained by using Giemsa stain. Red cell morphology was done on blood smear for theconfirmation of red cell indices. A total volume of 3 ml venous blood was drawn into a syringe. Out of which 1.0 ml was delivered into EDTA containing vacutainer and remaining 2 ml blood was transferred to a plain glass tube. After clotting and centrifugation serum was obtained for screening of hepatitis B surface antigen and antibodies against hepatitis C virus. Bone marrow aspiration was also performed where indicated. Megaloblastic anaemia (42%) Aplastic anaemia (26%) and ALL (8%) were found to be the common causes of pancytopenia in our scenario. Less common causes of pancytopenia were infections (8%), mixed deficiency (4%), MDS (4%) and lymphoma (4%). In all above mentioned cases clinical manifestations and peripheral blood counts played an important role in their evaluation. Two cases of haemophagocytic syndrome (2%), a rare cause of pancytopenia were also diagnosed in this study. This study also explained the importance of physical examination, peripheral blood findings and bone marrow examinations in the management of pancytopenic patients. Peripheral blood film and bone marrow aspiration should be performed simultaneously in pancytopenia patients when the diagnosis is not confirmed. Bone marrow examination in most cases gives the specific diagnosis. However, in few cases, additional tests may be required. Serum vitamin B12 and folic acid levels may be needed for confirmation of megaloblastic anemia. Serum iron, TIBC and iron staining on bone marrow smears may be required in iron deficiency anemia. In cases of leukemia flow cytometry study may be more helpful in reaching a final diagnosis. Bone marrow biopsy is mandatory in aplastic anemia.
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Pancytopenia is a hematological condition in which there is a decrease in all three cell lines of peripheral blood i.e. erythrocytes, leucocytes and platelets leading to anemia, leucopenia and thrombocytopenia. Complications of anemia, repeated infections and bleeding tendencies are sometimes horrifying and may result in death of individual.
The present study was designed to analyze the underlying pathology, different clinico-haematological features and importance of bone marrow study in one hundred children presenting with pancytopenia. Present study was carried out in pediatric laboratory of Mayo Hospital, Lahore, Pakistan..
Detailed history was taken in all cases. Complete blood counts were done on an automated blood analyzer (Sysmex Kx-21). For counter check of total leucocyte count, differential leucocyte count and platelets, smears were also prepared and stained by using Giemsa stain. Red cell morphology was done on blood smear for theconfirmation of red cell indices. A total volume of 3 ml venous blood was drawn into a syringe. Out of which 1.0 ml was delivered into EDTA containing vacutainer and remaining 2 ml blood was transferred to a plain glass tube. After clotting and centrifugation serum was obtained for screening of hepatitis B surface antigen and antibodies against hepatitis C virus. Bone marrow aspiration was also performed where indicated.
Megaloblastic anaemia (42%) Aplastic anaemia (26%) and ALL (8%) were found to be the common causes of pancytopenia in our scenario. Less common causes of pancytopenia were infections (8%), mixed deficiency (4%), MDS (4%) and lymphoma (4%). In all above mentioned cases clinical manifestations and peripheral blood counts played an important role in their evaluation.
Two cases of haemophagocytic syndrome (2%), a rare cause of pancytopenia were also diagnosed in this study.
This study also explained the importance of physical examination, peripheral blood findings and bone marrow examinations in the management of pancytopenic patients. Peripheral blood film and bone marrow aspiration should be performed simultaneously in pancytopenia patients when the diagnosis is not confirmed. Bone marrow examination in most cases gives the specific diagnosis. However, in few cases, additional tests may be required.
Serum vitamin B12 and folic acid levels may be needed for confirmation of megaloblastic anemia. Serum iron, TIBC and iron staining on bone marrow smears may be required in iron deficiency anemia. In cases of leukemia flow cytometry study may be more helpful in reaching a final diagnosis. Bone marrow biopsy is mandatory in aplastic anemia.

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