Pancytopenia in adult Iraqi patients in Medical City of Baghdad (A prospective and retrospective study)

Mahdy Raheem, Raheem

	Pancytopenia in adult Iraqi patients in Medical City of Baghdad (A prospective and retrospective study)
Kerbala Journal of Medicine
Article 11, Volume 2, Issue 5, 2009, Pages 616-622 PDF (0 K)
Author
Raheem Mahdy Raheem
Abstract
background: Pancytopenia is a term used to describe the simultaneous presence of anemia, leucopenia and thrombocytopenia. Different hematological and non hematological disorders may present with pancytopenia e.g. aplastic anemia, acute leukemia, megaloblastic anemia, etc... Aim of the study: The aim of this study is to identify the causes and presenting symptoms of pancytopenia in Iraqi patients. Patients and Methods: This study evaluated 173 patients admitted to Baghdad Teaching Hospital between January 2004 and August 2006. Criteria for inclusion were; anemia (PCV < 0.30 L/L), plus leucopenia (WBC count < 4 × 10 9 /L) and thrombocytopenia (platelet count < 100 × 10 9/L). Cases of pancytopenia induced by chemotherapy or radiotherapy were excluded. The adult patients were randomly selected regarding age and sex. This study included 94 male and 79 female patients, with age range from 15 to 79 years. Peripheral blood examination and bone marrow aspiration were done in all patients, while bone marrow biopsy done in 98 patients. Results: The major causes were acute leukemia in 66 (38.2 %) patients, aplastic anemia in 31 (17.9 %) patients, megaloblastic anemia in 29 (16.8 %) patients and myelodysplastic syndrome, non-Hodgkin lymphoma , systemic lupus erythematosus, hypersplenism, hairy cell leukemia, kala-azar, paroxysmal nocturnal haemoglobinuria and multiple myeloma constituted the remainder causes. The maximum age group of patients presented with pancytopenia ranging in 21-30 years with male to female ratio 1.2:1. The major presenting symptoms were bleeding tendency found in 69 (39.9 %) patients followed by easy fatigability found in 56 (32.4 %) patients and fever in 48 (27.7 %) patients , while common presenting signs were pallor, petechiae, splenomegaly, hepatomegaly and lymphadenopathy. The most common peripheral blood findings were anisopokoilocytosis, circulated immature cells and blasts cells. Conclusions: Acute leukemia, aplastic anemia and megaloblastic anemia are the major causes of pancytopenia, however, uncommon and rare causes like myelodysplastic syndrome, non-Hodgkin lymphoma, systemic lupus erythematosus, hypersplenism, hairy cell leukemia, kala-azar, paroxysmal nocturnal haemoglobinuria and multiple myeloma could be presented with pancytopenia. Major presenting symptoms were bleeding tendency, easy fatigability and fever, while common presenting signs were pallor, petechiae, splenomegaly, hepatomegaly and lymphadenopathy. Careful physical examination and peripheral blood smear examination play an important role in planning investigations of pancytopenia.

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