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Deciphering cytopenias in internal medicine: a single-center observational study
Simona Leoni1,2, Marta Ferraresi1,2, Irene Motta1,3
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy.
Insights
Cytopenias in hospitalized patients are often severe and secondary to comorbidities. A thorough initial workup is crucial before extensive testing for accurate diagnosis and management.
Area of Science:
- Internal Medicine
- Hematology
- Diagnostic Workup
Background:
- Cytopenia is a frequent and challenging complication in internal medicine inpatients.
- The diagnostic process for cytopenia can be lengthy and resource-intensive.
- Elderly patients with comorbidities are disproportionately affected.
Purpose of the Study:
- To analyze the characteristics and diagnostic yield of cytopenias in internal medicine inpatients.
- To evaluate the effectiveness of diagnostic tests in determining the cause of cytopenia.
- To identify factors contributing to severe cytopenias and patient outcomes.
Main Methods:
- Single-center observational study of 151 inpatients referred for cytopenia.
- Analysis of patient demographics, comorbidities, cytopenia types, severity, and diagnostic tests performed.
- Evaluation of discharge diagnoses and mortality causes.
Main Results:
- Anemia was the most common cytopenia (91%), followed by thrombocytopenia (51%) and neutropenia (22%).
- Two-thirds of cytopenias were secondary to comorbidities; only 35% received a hematologic diagnosis.
- Diagnostic tests had limited utility (34% informed discharge diagnosis); bone marrow biopsy was diagnostic in 69.6% of cases.
Conclusions:
- Cytopenias in internal medicine are often severe, frequently secondary to comorbidities, and require careful initial evaluation.
- The diagnostic workup is often inefficient, highlighting the need for optimized testing strategies.
- Prioritizing appropriate initial tests is essential before proceeding to more specialized and costly investigations.
Abstract:
Cytopenia is a common finding in patients admitted to internal medicine wards and the clinical workup may be long and time-consuming. In this single-center observational study, we analyzed a series of 151 inpatients who received hematologist referral due to cytopenia observed during hospital admission. Patients were mainly elderly (median 71 years, 15-96) and 87% had at least one comorbidity. Anemia was the most common cytopenia (91%), followed by thrombocytopenia (51%), and neutropenia (22%); 73 (48%) patients had a bicytopenia and 5 (3%) pancytopenia. Cytopenias were mainly severe, 66% of cases required RBC transfusions, and 21% platelet pools. During a median hospital stay of 15 days (1-166), 53 subjects (35%) received a hematologic discharge diagnosis, whilst the two-thirds had secondary cytopenia mainly due to associated comorbidities. Only about 34% of 2,728 diagnostic tests performed (including laboratory, imaging, and histology) clearly informed the discharge diagnosis in this heterogenous setting. Specifically, bone-marrow evaluation indicated in 46 (30%) patients, was diagnostic in 32 (69.6%). Eleven percent of patients died due to progression of the oncohematologic disease (29%), sepsis (24%), and solid tumor progression (24%). In conclusion, cytopenias in the internal medicine setting are mainly severe, more frequently secondary to associated comorbidities (2/3 of patients) and deserve proper workup before second/third-level tests (immune-hematological assays and CT scan or PET and bone-marrow evaluation, respectively).
