Pancytopenia demystified: A proposed diagnostic algorithm for the strategic evaluation of pancytopenia
DOI:
https://doi.org/10.55629/pakjpathol.v36i3.929Abstract
Objective: To design a simplified minimally invasive algorithm for strategic diagnostic approach towards pancytopenia by evaluating the etiological spectrum of pancytopenia in a tertiary care hospital.
Material and Methods: It was a retrospective study which was conducted at Fauji Foundation Hospital Rawalpindi. The duration of study was 3 years, i.e. January 2022 - January 2025. Patients of both genders and all ages who were diagnosed as having pancytopenia were included in the study. All pancytopenia were verified on peripheral smear. Results of other diagnostic workup done to identify the etiology of pancytopenia including reticulocyte count, malarial parasite (MP), serum iron profile, vitamin B12 levels, red blood cell (RBC) folate, blood cultures etc. and of different imaging techniques were noted.
Results: Out of total 216 patients 174 were females and 42 were male. Non-malignant cases in patients presented with pancytopenia were 181. Whereas 35 cases (16.2%) showed various malignant disorders. Among the non-malignant disorders, the most common etiology was infections (27%) followed by megaloblastic anemia (19%). In malignant disorders acute lymphoblastic and acute myeloid leukemia comprised the largest bulk (40%). Non-diagnostic marrows were 37%. After a thorough evaluation of generated data, a simplified algorithm is designed to opt for a strategic approach towards diagnosis of pancytopenia.
Conclusion: Among various causes of pancytopenia, megaloblastic infections and aplastic anemia were the most common causes. Thorough and logical evaluation and strategic diagnostic approach following algorithm will help to reduce mortality and morbidity in patients presenting with pancytopenia.
Keywords: Bone marrow examination, Malignant disorders, Pancytopenia.
References
Gajbhiye SS, Karwa AR, Dhok A, Jadhav SS. Clinical and etiological profiles of patients with pancytopenia in a tertiary care hospital. Cureus. 2022; 14(10): e30449. DOI: https://doi.org/10.7759/cureus.30449
Thain A, Hart K, Ahmadi KR. Addressing the gaps in the vitamin B12 deficiency 2024 NICE guidelines: highlighting the need for better recognition, diagnosis, and management of pernicious anemia. Eur J Clin Nutr. 2025; 79 (7): 607-10. DOI: https://doi.org/10.1038/s41430-025-01583-4
Tahir N, Ashraf A, Waqar SHB, Rafae A, Kantamneni L, Sheikh T, et al. Copper deficiency, a rare but correctable cause of pancytopenia: A review of literature. Expert Rev Hematol. 2022; 15(11): 999–1008. DOI: https://doi.org/10.1080/17474086.2022.2142113
Park M. Overview of inherited bone marrow failure syndromes. Blood Res. 2022;57(S1):49–54. DOI: https://doi.org/10.5045/br.2022.2022012
Kulasekararaj A, Cavenagh J, Dokal I, Foukaneli T, Gandhi S, Garg M, et al. Guidelines for the diagnosis and management of adult aplastic anemia: A British Society for Haematology guideline. Br J Haematol. 2024; 204(3): 784–804. DOI: https://doi.org/10.1111/bjh.19236
Hines MR, von Bahr Greenwood T, Beutel G, Beutel K, Hays JA, Horne A, et al. Consensus-based guidelines for the recognition, diagnosis, and management of hemophagocytic lymphohistiocytosis in critically ill children and adults. Crit Care Med. 2022; 50(5): 860–72. DOI:https://doi.org/10.1097/ccm.0000000000005361
Zhang Y, Chen X, Wang X, Chen J, Du C, Wang J, et al. Insights into ionizing radiation-induced bone marrow hematopoietic stem cell injury. Stem Cell Res Ther. 2024;15:222. DOI: https://doi.org/10.1186/s13287-024-03853-7
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4): 844–7. DOI: https://doi.org/10.1111/jth.14768
Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020; 136(4): 489–500. DOI: https://doi.org/10.1182/blood.2020006520
Hussain S, Hussain I, Ashfaq A, Karim LA, Mirza S, Zafar H. Bone marrow aplasia in Hemophilia-A with Hepatitis-C and human immunodeficiency virus co-infection: A case report. J Pak Med Assoc. 2022; 72(11): 2323–6. DOI: https://doi.org/10.47391/jpma.4659
Takele Y, Mulwa T, Adem E, Shaw CJ, Franssen SU, Womersley R, et al. Immunological factors, but not clinical features, predict visceral leishmaniasis relapse in patients co-infected with HIV. Cell Rep Med. 2022; 3(1): 100487.
DOI: https://doi.org/10.1016/j.xcrm.2021.100487
Adawiye A, Baydoun O, Samaha H, El Georges, Hachem. Gaucher disease on the ruins of multiple myeloma: an unusual presentation. Clin Lymphoma Myeloma Leuk. 2023; 23(1): S482. DOI: https://doi.org/10.1016/S2152-2650(23)014 19 -2
Çordan I, Tukek T. Evaluation of etiological causes and incidence of pancytopenia: a case series from a tertiary care center. Cureus. 2025; 17(2): e79485. DOI: https://doi.org/10.7759/cureus.79485
Takeshima M, Ishikawa H, Kitadate A, Sasaki R, Kobayashi T, Nanjyo H, et al. Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: A case report. BMC Psychiatry. 2018; 18(1): 150.
DOI: https://doi.org/10.1186/s12888-018-1743-6
Xiao N, Hao S, Zhang Y, Shao Z. Roles of immune responses in the pathogenesis of immunorelated pancytopenia. Scand J Immunol. 2020; 92(2): e12911. DOI: https://doi.org/10.1111/sji.12911
Fazal W, Khan S, Akhtar R, Khattak SA, Ali M, Kakakhel M. A comprehensive analysis of clinical presentations, laboratory findings, and etiologies of pancytopenia: a tertiary care experience. Cureus. 2024; 16(11): e73148.
DOI: https://doi.org/10.7759/cureus.73148
Farooque R, Iftikhar S, Herekar F, Patel MJ. Frequency and etiology of pancytopenia in patients admitted to a tertiary care hospital in Karachi. Cureus. 2020;12:e. DOI: https://doi.org/10.7759/cureus.11057
Patel GR, Prajapati GR. Spectrum of pancytopenia in adults attending a clinical hematology department: A four-year experience from a tertiary care center of western India. Cureus. 2022; 14: e24933. DOI: https://doi.org/10.7759/cureus.24933
Sreenivas S, Harika ML, Hyma T, Mounika G. Etiology of pancytopenia in a study in a tertiary care hospital in North Andhras. J Med Sci Clin Res. 2020; 8(8): 2455–450. DOI: https://doi.org/10.18535/JMSCR/V8I8.45
Ullah I, Khan D, Qureshi V. Etiological spectrum of bone marrow biopsy in patients with pancytopenia. Cureus. 2024; 16(11): e73138. DOI: https://doi.org/10.7759/cureus.73138
Zulfiqar M, Ali BA, Jiskani SA, Waqar M, Saad M, Javed H. Evaluation of pancytopenia based on bone marrow examination in adults in a tertiary care hospital in Islamabad. Prof Med J. 2023; 30(8): 1152–6.
DOI: https://doi.org/10.29309/TPMJ/2023.30.09.7575
Ullah I, Khan MS, Fayaz M, Khan SA, Khan N, Tabassum R. Understanding the etiologies of pancytopenia in pediatric patients: A cross-sectional study. Int J Biomed Res. 2025; 3(1): 185-9. DOI: https://doi.org/10.70749/ijbr.v3i1.384
Vargas-Carretero CJ, Fernandez-Vargas OE, Ron-Magaña AL, Padilla-Ortega JA, Ron-Guerrero CS, Barrera-Chairez E. Etiology and clinico-hematological profile of pancytopenia: experience of a Mexican tertiary care center and review of the literature. Hematol. 2019; 24(1): 399–404. DOI:https://doi.org/10.1080/16078454.2019.1590961
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