A Sep-wise Approach to Diagnose Pancytopenia: Experience from a Tertiary Care Hospital in AJ&K, Pakistan

Abstract

Objective: To find out the occurrence of pancytopenia in relation to the age and sex of the patients. To establish a step-wise approach by correlating the clinical, haematological and bone marrow findings to reach a diagnosis, and to evaluate the cause of pancytopenia individually.

Material and Methods: This study was a prospective study over a period of one year conducted at a teaching hospital of Mirpur, AJ&K, with a catchment population of 1.6 million with a wide range of diversity in its terrain ranging from plains to mountains. This was the first ever study conducted on this topic in this region. Basic tests including blood complete picture followed by peripheral film, Reticulocyte percentage, Bone marrow examination including aspiration and trephine biopsy along with other supportive tests were used to reach a diagnosis in each patient.

Results: Out of a total of 119 patients, with age ranging from 2 months to 90 years, the mean age was 59 years with female predominance. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Anaemia was the predominant finding in blood film examination. Bone marrow aspiration was conclusive in all cases. The commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. The commonest cause of pancytopenia was megaloblastic anaemia (74.04%), followed by aplastic anaemia (18.26%).

Conclusion: The present study concludes that detailed primary haematological investigations along with bone marrow studies in cytopaenic patients are helpful for understanding the disease process and diagnosis to rule out the causes of cytopaenia.