Clinico-Hematological Study of Pancytopenia with Special Reference to Idiopathic Pancytopenia

Abstract

Background: Pancytopenia may present with different clinical scenario in daily practice. The present study was carried out to find the various causes of pancytopenia in Varanasi and adjoining areas with special reference to Idiopathic pancytopenia. Material & Method: It was a prospective study conducted over a period of one year (Jan 2014-February 2015) at Department of Pathology in Institute of Medical sciences, Banaras Hindu University, Varanasi. Patients presenting with pancytopenia were included in the study. A provisional diagnosis was made on the clinical findings. Extensive laboratory work up (including LFT, RFT, Serology etc) was carried out to find the cause of pancytopenia in all the patients. Bone marrow aspiration was done in all the cases as a routine procedure. Bone marrow biopsy was done in 48 cases where indicated. Result: A total of 140 patients presented with pancytopenia. Among the causes, Aplastic anemia was the most common cause (31.4%) followed by Megaloblastic anemia (22.1%) The third common cause was Myelodysplastic syndrome (MDS) (12.9%) followed by Acute leukemia (11.4%). Other causes were hypersplenism (4.3%), kala azar (2.1%), drug induced (2.1%), two cases each of HIV (1.4%), myelofibrosis (1.4%), lymphoma (1.4%) & multiple myeloma (1.4%). One case each of ITP (0.7%), SLE (0.7%) and Fanconi anemia (0.7%). Idiopathic pancytopenia constituted 5% (7 cases) of the total. On follow up of patients with idiopathic pancytopenia at 6 months, all the seven patients were having persistent pancytopenia. They were labeled as ICUS (Idiopathic cytopenia of undetermined significance (ICUS)). One patient was hospitalized with complains of generalized body weakness and few episodes of malena. Thorough work up was done to look for any cause of pancytopenia but no cause was identified and patient died due to complication of pancytopenia (due to hemorrhagic shock) in one month course and hence “Idiopathic fatal pancytopenia” term was coined for the patient.