Details
Category: Volume 07 Issue 09 September 2019
Hits: 1033

Title: The role of bone marrow aspiration cytology in the evaluation of the etiology of pancytopenia in patients in a tertiary hospital in Telangana, India

Authors: Mohammed Moid Afzal, V.Indira, Colonel Ramanan Duraiswami

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.29

Abstract

    

Background: Pancytopenia is characterized by Anemia, Leukopenia & Thrombocytopenia. It is very often seen in day to day practice and requires thorough investigation to know the cause of Pancytopenia for timely and early management to improve the prognosis.

Material and Methods: This study was conducted in the Department of Pathology Malla Reddy Institute of Medical Sciences over a period of 2 years and six months from January 2017 to June 2019.Patients were in the age group of 18 months to 65 years. The ratio of male to female patients was 1:1.4. 109 patients were evaluated by Bone Marrow Aspiration cytology, complete blood picture by automated counter, which was confirmed by manual blood count along with peripheral blood examination, to establish the etiology. 43 patients who fulfilled the criteria for a diagnosis of pancytopenia were included in the study. The as patients underwent several diagnostic tests hemogram, biochemical test like serum B12,serum folic acid, serum ferritin, total iron binding capacity. Bone Marrow Aspiration cytology and Bone marrow biopsy were done. Routine Giemsa stain as well as cytochemical stains like Pearls stain, Reticulin stain and Periodic Acid Schiff test, were carried out on the bone marrow material.

Results: In the present study, the commonest cause of pancytopenia was found to be Megaloblatic Anemia (67.4%) followed by Hypoplastic Anemia (24.4%); the least common causes being infections (Malaria 2.3%), Aleukemic Leukemia (2.3%), Myelofibrosis (2.3%) and Myelodysplastic Syndrome (2.3%).

Conclusion: The majority of patients with pancytopenia are diagnosed by Bone Marrow Aspiration as an adjunct to clinical history, clinical examination, peripheral blood examination, hemogram and biochemical examination. Bone Marrow Aspiration cytology is an important diagnostic tool to establish unequivocally the cause of pancytopenia.

Keywords: Pancytopenia, Bone Marrow Aspiration cytology, Megaloblastic Anemia, Myelofibrosis, Lymphoproleferative Disorders.

References

  1. Varma A,Lokwani P, Malukarne K& others .Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India Medical journal of D.Y Patil Vidyapeeth. November/December 2108;11(6):512-18.
  2. Desal Phina M. Bagga PM, Gupta PK, Kateria AS. To evaluate the role of B.M.A&Bx in Pancytopenia. Journal clinical diagnostic Res.2014;8(11):11-5.
  3. Tareem SM, Bajwa MA, Tariq MM, Babar S, Tareem AM. Pancytopenia in two Nutritional ethics group of Baluchistan J.Ayub Medical College Abbotabad. 2011;23:82-6.
  4. Khonger JM, Arul Selvi S, Sharma V, Ranga S, Talib VH .Pancytopenia A clinico hematology study of 200 cases .Indian J.Pathol. Microbiol.2002;45:375-9.
  5. JahaA,Sayami G, Adhikari RC, Patna AD, Jhan R. Bone Marrow Aspiration in cases of Pancytopenia. JNMA J Nepal Med Asso.2008; 47(169):12-7.
  6. AZIZ T, Liaquat Ali L, Ansari T, Liaquat HB, Shah S, Jamal A. Pancytopenia Megaloblastic Anemia is still the commonest cause. Pak J Med Sci.2010;26:132-6.
  7. Pinal shah R, D Patil, Bhavna Gamit, Shruti Gheewala. Bone Marrow examination in case of Pancytopenia. International Journal of research & Medical Sciences. 2017 Apr;5(4):1994-98.
  8. Khalid G.Moosani MA, Ahmed L, Farooqi AN. Megaloblastic Anemia seen in 48 case of Pancytopenia. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll. 2005;10(2):742-9.
  9. Kav M. Ghosh A, Pancytopenia. J Indian acad clin Med 2002;3(1):29-34.
  10. Garcia-casal MN, Osorio C, Landaeta M, Leets I,Mayin P, Fazzino F etal, High Prevelance of folic acid and vit B12 deficiency in infants, children, adolescents& Pregnant Woman in Venezuela. Eur J Clin Nutr. 2005;59 (9):1064-70.
  11. Savage DG, Lindenbaum J, Stabler SP, Allen RH, Sensitivity of serum Methyl acid and total homo- cysteine determination for diagnosing cobalamin and folate deficiencies Am J Med 1994;96:239-46.
  12. Stabler SP, Allen RH, Vit B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326.
  13. Khodke K. Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow examination in case of Pancytopenia. JIACM 2001;2:55-59.
  14. Tilak V, Jain R. pancytopenia-A Clinico-Hematology Analysis of 77 cases. Indian J Pathol Microbiol 1999;42:399-404.
  15. Verma N, Dash S. A Reappraisal of underlying pathology in adult patients presenting with Pancytopenia. TROP Geogr Med. 1992;44:322-7.
  16. Kumar R, Kalra SP, Kumar H, Anand Ac, Madan H. Pancytopenia. A six year study. JAPI 2001;49:1078-1081.
  17. Bhajracharya SB, Pande R, Bhandari PB, Sinha R, Guragain P. An Approach to Aplastic Anemia. Medical Journal of Shree Birendra Hospital. In journal of the royal Nepalese army Medical Corps 2005;7:8283.

Corresponding Author

Colonel [Dr] Ramanan Duraiswami

Professor, Department of Pathology Malla Reddy Institute of Medical Sciences