CLINICOHAEMATOLOGICAL SPECTRUM OF PANCYTOPENIA IN A TERTIARY CARE HOSPITAL

Objective: To determine the frequency, clinical presentation and underlying causes of pancytopenia in patients presenting to a tertiary care hospital in Peshawar.Methodology: This cross-sectional, observational study was conducted at Department of Pathology, Lady Reading Hospital Peshawar from January to December 2011. Patients of all ages having pancytopenia on blood film examination (TLC 4000/ul, Hb 10 gm/dl and Platelets 150000/ul) were included in the study. Already diagnosed patients of Aplastic Anemia, Acute Leukemia receiving treatment and those not willing for bone marrow examination were excluded from the study. History, General Physical and systemic examination were recorded at presentation. The peripheral blood counts were performed with sysmex - automated hematology analyzer. Bone marrow aspiration and trephine biopsy were performed according to the standard protocol and examined microscopically to find the underlying cause of pancytopenia. Other relevant investigations were also done.Results: During the study period, we received 600 patients for bone marrow examination from various units. Out of these, 160 (26.7 %) patients had pancytopenia. Common clinical presentations were Pallor (95%, n=150), followed by generalized weakness (75%, n=120), fever (52%, n=83), bleeding manifestation (37.5%, n=60), gastrointestinal symptoms (32.5%, n=52) and splenomegaly (23.5%, n=38). The common causes of pancytopenia were aplastic anemia (37.5%, n=60) followed by magaloblastic anemia (13.75 %, n=22), Acute Leukemia (13.75%, n=22) and hypersplenism (10%, n=16).Conclusion: Pancytopenia is a common occurrence. Aplastic Anemia and Magaloblastic Anemia are the commonest causes of Pancytopenia followed by Acute Leukemia. Common clinical presentations were Pallor, fever, weakness, bleeding manifestation and Splenomegaly.