FREQUENCY AND CHARACTERISATION OF PANCYTOPENIA IN MEGALOBLASTIC ANAEMIA
AbstractBackground: 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
Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta
AK. Pancytopenia in children: etiological profile. J Trop Pediatr
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
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
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
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
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
Mishra D, Kohli A, Yadav RB, Nayak D. Megaloblastic anemia:
a common cause of pancytopenia in children. Indian J Pathol
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
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.