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Etiological spectrum of pancytopenia based on bone marrow examination in children
Shazia Memon1, Salma Shaikh, M Akbar A Nizamani
1Department of Paediatrics, Liaquat University of Medical and Health Sciences, Hyderabad. shaziamemon-ap@hotmail.com
Insights
Pancytopenia in children is common, often caused by aplastic anemia, leukemia, or infections. Early diagnosis through bone marrow examination is crucial for identifying treatable causes like megaloblastic anemia and infections.
Area of Science:
- Pediatric Hematology
- Clinical Pathology
- Internal Medicine
Background:
- Pancytopenia, a condition characterized by a deficiency in all three blood cell types, presents a significant diagnostic challenge in pediatric patients.
- Understanding the spectrum of causes, clinical manifestations, and etiological factors is essential for effective management.
Purpose of the Study:
- To investigate the frequency, clinical presentation, and underlying causes of pancytopenia in children aged 2 months to 15 years.
- To determine the diagnostic utility of bone marrow examination in identifying the etiology of pediatric pancytopenia.
Main Methods:
- An observational study was conducted involving pediatric patients diagnosed with pancytopenia.
- Exclusion criteria included age outside the specified range, pre-existing diagnoses of leukemia or aplastic anemia, suspected genetic causes, recent blood transfusions, and patient refusal for admission or bone marrow examination.
- Detailed patient history, physical examination, and hematological parameters, including peripheral smear and bone marrow aspiration/biopsy, were analyzed.
Main Results:
- Pancytopenia was observed in 3.57% of pediatric admissions, with 230 patients ultimately studied.
- The most frequent causes identified were aplastic anemia (23.9%), megaloblastic anemia (13.04%), leukemia (13.05%), enteric fever (10.8%), malaria (8.69%), and sepsis (8.69%).
- Common clinical signs included pallor, fever, petechial hemorrhages, visceromegaly, and bleeding.
Conclusions:
- Pancytopenia is a frequent hematological finding in pediatric populations.
- While acute leukemia and bone marrow failure represent significant causes, infections and megaloblastic anemia are common, treatable, and reversible conditions that require prompt identification.
Objective:
To determine the spectrum of pancytopenia with its frequency, common clinical presentation and etiology on the basis of bone marrow examination in children from 2 months to 15 years.
Design:
Observational study.
Place And Duration Of Study:
Department of Paediatrics, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from October 2005 to March 2007.
Patients And Methods:
All patients aged 2 months to 15 years having pancytopenia were included. Patients beyond this age limits, already diagnosed cases of aplastic anemia and leukemia, clinical suspicion of genetic or constitutional pancytopenia, history of blood transfusion in recent past, and those not willing for either admission or bone marrow examination were excluded. History, physical and systemic examination and hematological parameters at presentation were recorded. Hematological profile included hemoglobin, total and differential leucocyte count, platelet count, reticulocyte count, peripheral smear and bone marrow aspiration/biopsy.
Results:
During the study period, out of the 7000 admissions in paediatric ward, 250 patients had pancytopenia on their peripheral blood smear (3.57%). Out of those, 230 patients were finally studied. Cause of pancytopenia was identified in 220 cases on the basis of bone marrow and other supportive investigations, while 10 cases remained undiagnosed. Most common was aplastic anemia (23.9%), megaloblastic anemia (13.04%), leukemia (13.05%), enteric fever (10.8%), malaria (8.69%) and sepsis (8.69%). Common clinical presentations were pallor, fever, petechial hemorrhages, visceromegaly and bleeding from nose and gastrointestinal tract.
Conclusion:
Pancytopenia is a common occurrence in paediatric patients. Though acute leukemia and bone marrow failure were the usual causes of pancytopenia, infections and megaloblastic anemia are easily treatable and reversible.
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