Pancytopenia in adult Iraqi patients in Medical City of Baghdad (A prospective and retrospective study)

Abstract

background: Pancytopenia is a term used to describe the simultaneouspresence of anemia, leucopenia and thrombocytopenia. Differenthematological and non hematological disorders may present withpancytopenia e.g. aplastic anemia, acute leukemia, megaloblastic anemia, etc...Aim of the study: The aim of this study is to identify the causes and presentingsymptoms of pancytopenia in Iraqi patients.Patients and Methods: This study evaluated 173 patients admitted to BaghdadTeaching Hospital between January 2004 and August 2006. Criteria for inclusionwere; anemia (PCV < 0.30 L/L), plus leucopenia (WBC count < 4 × 10 9 /L) andthrombocytopenia (platelet count < 100 × 10 9/L). Cases of pancytopenia induced bychemotherapy or radiotherapy were excluded. The adult patients were randomlyselected regarding age and sex. This study included 94 male and 79 female patients,with age range from 15 to 79 years. Peripheral blood examination and bone marrowaspiration were done in all patients, while bone marrow biopsy done in 98 patients.Results: The major causes were acute leukemia in 66 (38.2 %) patients, aplasticanemia in 31 (17.9 %) patients, megaloblastic anemia in 29 (16.8 %) patients andmyelodysplastic syndrome, non-Hodgkin lymphoma , systemic lupus erythematosus,hypersplenism, hairy cell leukemia, kala-azar, paroxysmal nocturnal haemoglobinuriaand multiple myeloma constituted the remainder causes. The maximum age group ofpatients presented with pancytopenia ranging in 21-30 years with male to female ratio1.2:1. The major presenting symptoms were bleeding tendency found in 69 (39.9 %)patients followed by easy fatigability found in 56 (32.4 %) patients and fever in 48(27.7 %) patients , while common presenting signs were pallor, petechiae,splenomegaly, hepatomegaly and lymphadenopathy. The most common peripheralblood findings were anisopokoilocytosis, circulated immature cells and blasts cells.Conclusions: Acute leukemia, aplastic anemia and megaloblastic anemia are themajor causes of pancytopenia, however, uncommon and rare causes likemyelodysplastic syndrome, non-Hodgkin lymphoma, systemic lupus erythematosus,hypersplenism, hairy cell leukemia, kala-azar, paroxysmal nocturnal haemoglobinuriaand multiple myeloma could be presented with pancytopenia. Major presentingsymptoms were bleeding tendency, easy fatigability and fever, while commonpresenting signs were pallor, petechiae, splenomegaly, hepatomegaly andlymphadenopathy. Careful physical examination and peripheral blood smearexamination play an important role in planning investigations of pancytopenia.