FREQUENCY AND CHARACTERISATION OF PANCYTOPENIA IN MEGALOBLASTIC ANAEMIA

Authors

  • Muhammad Bilal Khattak
  • Mohammad Ismail
  • Zahid Irfan Marwat
  • Faramoz Khan

Abstract

Background: A wide variety of clinical conditions, that primarily or secondarily affect the bonemarrow may present with pancytopenia, one of such conditions is megaloblastic anaemia. The purposeof this study was to determine the frequency and nature of pancytopenia in megaloblastic anaemia.Methods: This was a prospective, cross-sectional descriptive study conducted in Medical Units, AyubTeaching Hospital, Abbottabad, Pakistan during July 2010–January 2011. Total 90 patients wereincluded in this study. Data were collected including history, clinical examination, haemoglobin level,mean cell volume, bone marrow examination and peripheral smear examination. Results: Of total 90patients, 54 were male and 36 were female. Mean age was 28±15.84 years. Common presentingfeatures were weakness, fever and bleeding manifestations. Pancytopenia was present in 63 (70%)patients. Most common presenting feature related to anaemia was weakness (80%). Bleedingmanifestations, related to low platelet count were found in 35 (39%) patients. Physical Examinationfindings were: pallor (100%), splenomegaly (33%), bleeding manifestations (25%), hepatomegaly(17%), and hepatosplenomegaly (19%). Mean peripheral blood findings of the study populationincluded haemoglobin level (6.25 g/dL), total leukocyte count (2818.7/μL), platelet count (44040/uL),and reticulocyte count (1.7%). Mean values for red cells indices included red blood cells count (2.6million/uL), mean corpuscular volume (114.3 fL), mean corpuscular haemoglobin (27.3 ρg) and meancorpuscular haemoglobin concentration (31.8 g/dL). Conclusions: In megaloblastic anaemia,pancytopenia is a common and important clinical and haematological problem. Patients should beproperly investigated for pancytopenia and its causes because many of them are completely curablewhile others are manageable. This will help to reduce patients’ suffering, improve quality of life andprolong survival.Keywords: Pancytopenia, megaloblastic anaemia, bone marrow aspiration, acute leukaemia, aplasticanaemia, hypersplenism

References

Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta

AK. Pancytopenia in children: etiological profile. J Trop Pediatr

;51(4):236–9.

Gayathri BN, Rao KS. Pancytopenia: a clinico-hematological

study. J Lab Physicians 2011;3(1):15–20.

Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow

examination in cases of pancytopenia. J Nepal Med Assoc

;47(169):12–7.

Bates I, Bain BJ. Approach to diagnosis and classification of

blood diseases. In: Lewis SM, Bain BJ, Bates I, Eds. Practical

Haematology, 10th ed. Philadelphia: Elsevier Churchill

livingstone; 2006.p. 615.

Ishtiaq O, Baqai HZ, Anwer F, Hussain N. Patterns of

pancytopenia patients in a general medical ward and a proposed

diagnostic approach. J Ayub Med Coll Abbottabad

;16(1):8–13.

Simsek OP, Gonc N, Gumruk F, Cetin M. A child with vitamin

B12 deficiency presenting with pancytopenia and

hyperpigmentation. J Pediatr Hematol Oncol 2004;26:834–6.

Chandra J. Megaloblastic anemia: back in focus. Indian J Pediatr

;77:795–9.

Khanduri U, Sharma A. Megaloblastic anaemia: prevalence and

causative factors. Natl Med J India 2007;20(4):172–5.

Ziaei JE, Dastgiri S. Role of myeloperoxidase index in

differentiation of megaloblastic and aplastic anemia. Indian J

Med Sci 2004;58:345–8.

Hoffbrand AV, Green R. Megaloblastic anemia. In: Hoffbrand

AV, Catovsky D, Tuddenham EGD, Eds. Postgraduate

Haematology, 5th ed. UK: Blackwell; 2005.p. 65–6.

Chandra H, Chandra S, Rawat A, Verma SK. Megaloblastic

pancytopenia vis-a-vis non-megaloblastic pancytopenia: is mean

platelet volume useful discriminating indicator. Int J Lab

Hematol 2011;33:409–3.

Halfdanarson TR, Walker JA, Litzow MR, Hanson CA. Severe

vitamin B12 deficiency resulting in pancytopenia, splenomegaly

and leukoerythroblastosis. Eur J Haematol 2008;80:448–51.

Masoodi I, Kakar A, Byotra SP, Sachdev MK, Hussain S.

Hemorrhagic manifestation of megaloblastic anemia: Report of

two cases and literature review. Blood Coagul Fibrinolysis

;22:234–5.

Mishra D, Kohli A, Yadav RB, Nayak D. Megaloblastic anemia:

a common cause of pancytopenia in children. Indian J Pathol

Microbiol 2007;50:447–8.

Memon S, Shaikh S, Nizamani MA. Etiological spectrum of

pancytopenia based on bone marrow examination in children. J

Coll Physicians Surg Pak 2008;18(3):163–7.

Zlotkin S. A new approach to control of anaemia in ‘at risk’

infants and children around the world. Ryley-Jeffs memorial

lecture. Can J Diet Pract Res 2004;65:136–8.

Hamid GA, Shukry SAR. Patterns of pancytopenia in Yemen.

Turk J Hematol 2008;25(2):71–4.

Niazi M, Raziq F. The incidence of underlying pathology in

pancytopenia-an experience of 89 cases J Postgrad Med Inst

;18(1):76–9.

Gupta PK, Saxena R, Karan AS, Choudhry VP. Red cell indices

for distinguishing macrocytosis of aplastic anaemia and

megaloblastic anaemia. Indian J Pathol Microbiol 2003;46:375–7.

Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH.

Pancytopenia –a clinico-haematological study of 200 cases.

Indian J Pathol Microbiol 2002;45:375–9.

Toyokawa Y, Kingetsu I, Yasuda C, Yasuda J, Yoshida K,

Kurosaka D, et al. Pancytopenia, including macrocytic anemia,

associated with leflunomide in a rheumatoid arthritis patient.

Mod Rheumatol 2007;17:436–40.

Downloads

Published

2012-12-01