European Journal of Cardiovascular Medicine

Pancytopenia is a condition where the formed elements of blood i.e RBC,WBC,PLATELETS are lower than the normal reference range. pancytopenia is a triad of anemia, leukopeniaand thrombocytopenia. various conditions which directly or indirectly involve bone marrow manifest as pancytopenia. etiology of pancytopenia ranges from simple drug induced bone marrow hypoplasia, deficiency like vit B12, folic acid to life threatening leukemias. To know the exact etiology of pancytopenia is atmost important for the therupetic purpose and prognosis.

Sir William Harvey described blood as ‘fountain of life and the primary seat of soul. The marrow in our bones is the seedbed of our blood¹. examination of bone marrow is critically important in study and management of wide variety of hematological disorders. spectrum of disorders primarily or secondarly affecting bone marrow may manifest as pheripheral pancytopenia² .pancytopenia is disorder in which all three major formed elements in blood (RBC,WBC,PLATALETS) are below the normal reference range³ .presenting symptom is often attributed to anemia/thrombocytopenia. leukopenia is an uncommon cause of initial presentation but can become the most serious threat to life during the course of disorder^4,5. pancytoenia is serious hematological problem, the underlyning cause of which is diagnosed by bonemarrow examination. underlyning pathology determines the management and prognosis of patients ,hence its extremely important to study the etiology of pancytopenia.

This observational study was conducted among  patients admitted in the Department of Medicine in K R hospital Mysuru,Karnataka Definition of study subject; Adult male and female with pancytopenia. Study period was 18 months (From January 2019 to june 2020). Ethical clearance was taken from the institutional ethical committee

Secondary source of information from published articles, journals, books, case sheets, discharge summary, related websites were used in planning, developing synopsis and during dissertation as supporting document.

METHODS OF COLLECTION OF DATA

• Patient history and clinical examination will be done by personal interview or collection of medical records as per above mentioned criteria.
• After getting written consent from the patient, bone marrow aspiration and trephine biopsy wherever possible will be done by using Salah’s needle and Jamshidi needle respectively if needed.

Sample Size:

 Sample size calculated is 35 with level of confidence as 5% and absolute allowable error as 5% with prevalence of pancytopenia being 2% using confidence interval technique.

Inclusion criteria:

All the cases of pancytopenia with Haemoglobin less than 10gm/dl, White blood cell count less than 4000 cells/cumm and platelet count less than 1,50,000 cells/cumm admitted in K R hospital ,Mysuru.

Exclusion criteria: 

• Patients on cytotoxic drugs.
• Patients on radiotherapy.
• Patients with known case of ITP.
• Patients who undergone blood transfusion within 3 months.
• Patients taken vitamin supplements within 3 months

The study requires following investigations

• Complete blood count
• Peripheral Smear examination
• Bone Marrow aspiration and biopsy
• LFT
• Abdominal ultrasound
• Blood for Malarial parasite
• HIV
• Chest X ray
• Serological tests for enteric fever
• Special investigation – like ANA profile,vit b12 levels ,folic acid levels
• Written informed consent was taken from all subjects and their attenders.

DATA ANALYSIS:

• Appropriate statistical methods will be used to compute frequency tables and proportions .
• Data will be expressed either mean, standard deviation,frequency and percent.
• The chi-square test will be adopted for comparison of the prevalence data.
• Cramers test to found association between rows and coloumns.

Total 35 patients aged between 19 to 81 years age group presenting with pancytopenia are evaluated. Combined evaluation of physical findings, primary hematological investigation and bone marrow examination were done in all patients. Commonest age group affected is 31-40 years. Males accounted for 19 cases (54%), females 16 cases (46%).

TABLE- 1  -VITAL HEMATOLOGICAL PARAMETERS

FIGURE- 08 - VITAL HAEMATOLOGICAL PARAMETERS, HAEMOGLOBIN

FIGURE- 02 -VITAL HAEMATOLOGICAL PARAMETERS,TLC

FIGURE- 3  -VITAL HAEMATOLOGICAL PARAMETERS,PLATELET

Lowest hemoglobin percentage was 2.6 g/dl and noted in case of megaloblastic anemia. Lowest total leucocyte count was 500 cells per cubic mm. Lowest platelet count is 8000 cells per cubic mm Hypercellular marrow was noted in 26 cases and hypocellular marrow noted in 7 cases.normocellular marrow in 2 cases.

TABLE- 2  -PERIPHERAL BLOOD SMEAR IN PANCYTOPENIA

FIGURE- 4 -PERIPHERAL BLOOD SMEAR IN PANCYTOPENIA

Most common peripheral blood finding is macrocytic picture(54.29%) and least common is microcytic picture(8.56 %)

TABLE-3  -BONE MARROW CELLULARITY

FIGURE-4 -BONE MARROW CELLULARITY

Most common is hypercellular(74.29%) and least common is normocellular(5.71%).

Pancytopenia is commonly seen in various clinical settings all over the world. Total 35 cases of pancytopenia were studied from Jan 2019 to Jun 2020 at KR hospital, Mysuru.

FIGURE -5- comparison of haemoglobin values between our study and study done by gayathri et al in megaloblastic group.

FIGURE-6-Comparison of WBC values between our study and study done by gayathri et al

FIGURE -7 - comparison of platelet values with our study and study done by gayathri et al in megaloblastic group.

The findings of above study also indicates the prompt identification of patients with megaloblastic anemia and treating the underlyning cause in initial stage itself can reduce the incidence of pancytopenia and its various complications.

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2. Kishore khodke, S marwah,G buxi, RB Yadav, NK Chaturvedi. bone marrow examinations in case of pancytopenia.Joural of indian academy of clinical medicine 2001;1;55-59.
3. Firkin F,chesterman C,pennigton D,Rush B.De Gruchy clinical haematology in medical pactice.5^th Landon ;Blackwell science ltd 1989.p.119-36.
4. Segel GB, Lichtman MA.aplastic anemia;acquired and inherited .in;licthman MA.beutler E ,kipps TJ,seligsohm U, kaushan sky. prchal JT, editors. williams haematology.7^th edition .newyork; McGraw-hill medical;2006.p.419-30.
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