ETIOLOGICAL SPECTRUM OF PANCYTOPENIA USING BONE MARROW ASPIRATION AND BIOPSY

Abstract

Objective: The objective of this study was to analyse the etiology of pancytopenia in our setup using bone marrow biopsy, thus highlighting the diagnostic importance of bone marrow biopsy examination and helping to develop an approach in management of this condition.

Study design: Cross sectional descriptive study.

Place and duration of the study:  Khyber Teaching Hospital, Peshawar, from 1.1.2016 to 31.12.2016.

Materials & Methods: The 79 patients of all ages and both gender referred for bone marrow biopsy having pancytopenia were included in the study. Hemoglobin level below 10gm/dL, white cell count of less than 4x10⁹/L and platelet count below 150x10⁹ were taken as the criteria for pancytopenia. Pancytopenia was reported by automated cell counter. Low platelet count was confirmed by peripheral blood film examination. Bone marrow aspiration and biopsy were done. The findings were recorded in proforma and results were drawn accordingly.

Results: During the study period, about 79 patients fulfilled the criteria for pancytopenia. About 3 patients had diluted bone marrow aspirate which was unfit for making final diagnosis that’s why they were excluded. Remaining 76 patients with pancytopenia were included in the study. Age of study subjects ranged from 1 to 65 years (mean age 31 years ± 16.3 SD). 41(54%) males, and 35 (46%) females, male to female ratio of 1.2: 1. Among 76 cases, the commonest non-malignant etiology for pancytopenia on bone marrow examination was megaloblastic anemia, which was seen in 16(21%) cases. Commonest malignant etiology was acute leukemia which was seen in 10.6% cases (i.e. 5.3 % Acute myeloid leukemia and 5.3% Acute lymphoblastic leukemia), and mononuclear infiltration (seen in 10.5 % cases). Myelodysplasia and myelofibrosis were seen in 3 (3.9%) cases. Chronic lymphocytic leukemia, Gaucher’s disease, mixed deficiency anemia and Niemann pick disease were seen in 2 (2.6%) cases each. Anemia of chronic disorder, Malaria, hemolytic anemia, multiple myeloma, visceral leishmaniasis, and hemophagocytic lymphohistiocytosis were seen in 1 (1.3%) case of pancytopenia.

Conclusion: Megaloblastic anemia was the commonest, non-malignant cause, while acute leukemia was the commonest, malignant cause of pancytopenia. It was through the bone marrow aspiration biopsy examination that such a wide spectrum of diagnoses was made in patients presenting with the single finding of pancytopenia. Hence, bone marrow aspiration biopsy is useful diagnostic tools in evaluating pancytopenia.

Keywords:  Pancytopenia, Bone marrow, Megaloblastic anemia.