ETIOLOGICAL SPECTRUM OF CYTOPENIAS IN ADULT PAKISTANI POPULATION: A SINGLE CENTRE EXPERIENCE

Main Article Content

Saima Mehboob
Faridullah Shah
Sardar Muhammad
Iftikhar Ali Shah
Akhtar Zarin

Abstract

ABSTRACT

OBJECTIVE: To determine the frequency and etiology of various cytopenias in adult patients presenting to the medical unit of Kuwait Teaching Hospital, Peshawar, Pakistan.

METHODS: The study was conducted from January 2015 till June 2016, on 115 patients presenting to medical unit of Kuwait Teaching Hospital, Peshawar, Pakistan. Out of these 62 (54%) were males and 53 (46%) were females. Patients above 15 years of age having various cytopenias on complete blood count were included in the study. This was followed by peripheral smear examination. Bone marrow aspiration and trephine biopsy was performed where indicated. The data was further stratified into pancytopenia, thrombocytopenia and anemia and their respective causes with frequencies were calculated.

 RESULTS: Pancytopenia was detected in 66/115 (57.4%) cases. Megaloblastic anemia (n=29/66; 43.9%), aplastic anemia (n=10/66; 15.2%) and acute leukemia (n=10/66; 15.2%) were the major causes of pancytopenia. Other causes of pancytopenia included multiple myeloma (n=9/66; 13.6%), disseminated intravascular coagulation (n=4/66; 6.1%), myelo-suppression (n=2/66; 3%) and myelodysplasia (n=2/66; 3%). Thrombocytopenia was diagnosed in 44/115 (38.3%) cases. Vivax malaria (n=19/44; 43.2%), idiopathic thrombocytopenic purpura (n=11/44; 25%), hypersplenism (n=7/44; 15.9%) and dengue hemorrhagic fever (n=4/44; 9.1%) were the main causes of thrombocytopenia. Iron deficiency anemia was observed in 5/115 (4.3%) cases, all were females.

CONCLUSION: Pancytopenia and thrombocytopenia are the commonest cytopenias encountered in adult patients presenting to a medical unit in our hospital. Megaloblastic anemia is the commonest cause of pancytopenia followed by aplastic anemia and leukemia. In thrombocytopenia, vivax malaria and idiopathic thrombocytopenic purpura were the commonest causes.

KEY WORDS: Cytopenias (Non-MeSH); Thrombocytopenia (MeSH); Pancytopenia (MeSH); Anemia (MeSH); Peripheral smear (Non-MeSH); Bone marrow (MeSH); Trephine biopsy (Non-MeSH); Biopsy (MeSH); Anemia, Iron-Deficiency (MeSH).

Article Details

How to Cite
Mehboob, S., F. Shah, S. Muhammad, I. A. Shah, and A. Zarin. “ETIOLOGICAL SPECTRUM OF CYTOPENIAS IN ADULT PAKISTANI POPULATION: A SINGLE CENTRE EXPERIENCE”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 9, no. 4, Jan. 2018, pp. 188-91, https://www.kmuj.kmu.edu.pk/article/view/17399.
Section
Original Articles
Author Biography

Sardar Muhammad, Department of Medicine, Kuwait Teaching Hospital, Peshawar Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan

Assistant Professor Microbiology

Peshawar Medical College

References

REFERENCES

Iqbal W, Hassan K, Ikram N, Nur S. Aetiological breakup of 208 cases pancytopenia. J Rawal Med Coll 2001; 5(1):7-9.

Qazi RA, Masood A. Diagnostic evaluation of pancytopenia. J Rawal Med Coll 2002; 6(1):30-3.

Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. J Nepal Med Assoc 2008 Jan-Mar; 47(169):12-7

Gayathri BN and Rao KS. Pancytopenia: a clinico hematological study. J Lab Physicians 2011 Jan;3(1):15-20. DOI: 10.4103/0974-2727.78555

Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol 2013 Jan;139(1):9-29. DOI: 10.1309/AJCP50AEEYGREWUZ

Wallace MR, Hale BR, Utz GC, Olson PE, Earhart KC, Thornton SA, et al. Endemic infectious diseases of Afghanistan. Clin Infect Dis 2002 Jun;34(Suppl 5):S171-207. DOI: 10.1086/340704

Mussarat N, Raziq F. The incidence of underlying pathology in pancytopenia - An experience of 89 cases. J Postgrad Med Inst 2004; 18(1).76-9.

Jan AZ, Zahid B, Ahmad S, Gul Z. Pancytopenia in children: A 6-year spectrum of patients admitted to Pediatric Department of Rehman Medical Institute, Peshawar. Pak J Med Sci 2013; 29(5):1153-7.

Memon S, Shaikh S, Nizamani MA. Etiological spectrum of pancytopenia based on bone marrow examination in children. J Coll Physicians Surg Pak. 2008 Mar;18(3):163-7. doi: 03.2008/JCPSP.163167.

Rahim F, Ahmad I, Islam S, Hussain M, Khattak TAK, Bano Q. Spectrum of hematological disorders in children observed in 424 consecutive bone marrow aspirations/biopsies. Pak J Med Sci 2005;21(4):433-6.

Tareen SM, Bajwa MA, Tariq MM, Babar S, Tareen AM. Pancytopenia in two national ethnic groups of Baluchistan. J Ayub Med Coll 2011; 23(2):82-6.

Modood-ul-Manan, Anwar M, Saleem M, Wigar A, Ahmad M. A study of serum vitamin B12 and folate levels in patients of megaloblastic anaemia in northern Pakistan. J Pak Med Assoc 1995; 45(7):187-8.

Durrani SH, Sayyar M, Lal A, Aslam R. Incidentally diagnosed bicytopenia showing a wide spectrum of pathologies on bone marrow morphology. Khyber J Med Sci 2015;8(2):247-50.

Khan SJ, Abbass Y, Marwat MA. Thrombocytopenia as an indicator of malaria in adult population. Malar Res Treat 2012;2012:405981. DOI:10.1155/2012/405981

Tilak V, Jain R. Pancytopenia -- a clinico-hematologic analysis of 77 cases. Indian J Pathol Microbiol 1999 Oct; 42(4):399-404.

Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta AK. Pancytopenia in children: etiological profile. J Trop Pediatr. 2005 Aug;51(4):236-9. Epub 2005 Jul 13. DOI: 10.1093/tropej/fmi010

Kumar R, Kalra SP, Kumar H, Anand AC, Madan H. Pancytopenia - a six-year study. J Assoc Physicians India 2001 Nov;49:1078-81.

Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow Examination in cases of pancytopenia. J Ind Acad Clin Med 2001;2:55-9.

Bashwri LA. Bone marrow examination. Indications and diagnostic value. Saudi Med J 2002; 23(2):191-6.

Varma N, Dash S. A reappraisal of underlying pathology in adult patients presenting with pancytopenia. Trop Geogr Med 1992 Oct;44(4):322-7.

Savage DG, Allen RH, Gangaidzo IT, Levy LM, Gwanzura C, Moyo A, et al. Pancytopenia in Zimbabwe. Am J Med Sci 1999;317(1): 22-32