Clinical Characteristics and Etiological Spectrum of Pancytopenia in Pediatric Age Group: A Cross-Sectional Outlook From a Developing Country

Zubair, Abdullah Bin; Razzaq, Mustafa Tauseef; Hashmi, Abdul Wasey; Ali, Syed Muhammad Yasir; Israr, Muhammad Muneeb; Sadiq, Saad Mustafa; Khan, Muhammad Fahad; Haider, Zaki; Sabir, Muzammil; Kaneez, Mehwish

doi:10.7759/cureus.27842

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…To find the prevalence of different types of pancytopenia in the pediatric population, Zubair et al, 14 MCV was 90.9 fl, MCH was 30.1 pg, MCHC was 33.1%, and retic count was 1.21%. The mean Hb was 5.31 g/dL and TLC was 2492.68/mm 3 .…”

Section: Discussionmentioning

confidence: 99%

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Vijay Anand M,

Logeshwaran K,

Srenivas A

et al. 2024

Asian J Med Sci

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Background: Children who develop cytopenias present with several etiological causes, posing diagnosis, and management difficulties for both physicians and pathologists. With these in mind, we assessed the clinical profile and etiology of children who attended a healthcare facility in South India with bicytopenia or pancytopenia. Aims and Objectives: (1) The primary objective of this study was to find out the clinical and etiological spectrum in children with bicytopenia and pancytopenia who were admitted to the Institute of Child Health and Research Center, Government Rajaji Hospital, Madurai. (2) The secondary objective of this study is to follow-up children with bicytopenia and pancytopenia to find out the outcome and prognosis. Materials and Methods: This study was in the Department of Pediatrics at the Government Rajaji Hospital in Madurai, Madurai Medical College’s Institute of Child Health and Research Center, which is where we carried out the study. Two hundred and sixty-four patients with bicytopenia and 36 patients with pancytopenia were included in this study. Once in 2 weeks, all children with bicytopenia and pancytopenia were assessed in our Saturday hematology outpatient clinics. Results: Fever was the most prevalent sign of both pancytopenia and bicytopenia in this investigation. Etiological variables among cases of pancytopenia, cancer, infections, non-infections, and idiopathic causes were recorded in 11%, 58%, 17%, and 14% of cases, respectively. Similarly, bicytopenia, malignancy, infections, non-infections, and idiopathic causes were found in 23%, 70%, 4%, and 3% of cases, respectively. According to the prognosis, 28%, 33%, 6%, and 33% of cases with pancytopenia recovered, passed away, were lost to follow-up, or were undergoing treatment, respectively. Similar to those individuals, 67%, 11%, 4%, and 18% of bicytopenia cases were treated, recovered, or lost to follow-up, respectively. Conclusion: In children, there is a wide etiological range of cytopenias. Infections and dangerous diseases like acute leukemia are among the reasons. The geographical location of the hospital, the frequency of malnutrition, and the regional presence of certain diseases such as malaria and enteric fever determine the causes reported in a hospital environment.

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Section: Discussionmentioning

confidence: 99%

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Vijay Anand M,

Logeshwaran K,

Srenivas A

et al. 2024

Asian J Med Sci

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“…Pancytopenia is very common hematological condition in our population. 17,18 Patients with symptoms like bleeding, bruises, fever etc must be investigated for pancytopenia using complete blood count. 19 As a wide variety of malignant and non-malignant diseases can be presented with complaints related to pancytopenia.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pancytopenia based on bone marrow examination in adults in a tertiary care hospital in Islamabad.

Maryam Zulfiqar,

Bushra Anam Ali,

Shahzad Ali Jiskani

et al. 2023

TPMJ

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Objective: To evaluate etiological spectrum of pancytopenia in adults using bone marrow aspiration biopsy. Study Design: Randomized Prospective study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2018-October 2020. Material & Methods: Eight hundred bone marrow biopsies were performed out of which 250 patients came with pancytopenia. 135 patients out of these were in adult age group which are included in this study. Results: Out of 250 patients adults were 135 that presented with pancytopenia. Male to female ratio came out to be 1.22:1. The most common disorder that results in pancytopenia came out to be megaloblastic anemia that was 29.6%, after that 26.6% were infection related changes, 10.3% aplasia, 9.6% reactive marrow, 5.9% acute leukemia, 3.7% chronic leukemia and iron deficiency anemia followed by 2.9% myelodysplastic syndromes and hypersplenism, 2.2% multiple myeloma, 1.4% mixed deficiency anemia and 0.74% myelofibrosis. We also analyzed patients on their presenting complaints as well. Most common complaint of presentation was fever (54.8%), (31.85%) with fatigue and malaise, (31.1%) pallor, vomiting and diarrhea (25.9%) followed by bleeding (14.8%). On clinical examination 12% cases presented with hepatomegaly and 16.6% with splenomegaly. Conclusion: Pancytopenia is a common hematological finding in our setup with megaloblastic anemia to be the most common cause of it. Therefore, it’s very important to diagnose it as this is a curable (reversible) deficiency and patients can easily be managed to prevent serious hematological and neurological abnormalities.

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“…Disseminated tuberculosis (368)(369)(370)(371) or even disseminated BCG vaccination (372) can induce BM hypoplasia and peripheral cytopenia. The fact that tuberculosis-induced AHF occurs only in disseminated tuberculosis instead of in isolated pulmonary tuberculosis suggests that tuberculosis can infect hematopoietic tissues (373) or the gastrointestinal tract (34, 35, 181, 349).…”

Section: The More Important Role Of Gut Involvement In Tuberculosis I...mentioning

confidence: 99%

When inflammatory stressors dramatically change, disease phenotypes may transform between autoimmune hematopoietic failure and myeloid neoplasms

Zhao,

Ju,

Xiu

et al. 2024

Front. Immunol.

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Aplastic anemia (AA) and hypoplastic myelodysplastic syndrome are paradigms of autoimmune hematopoietic failure (AHF). Myelodysplastic syndrome and acute myeloid leukemia are unequivocal myeloid neoplasms (MNs). Currently, AA is also known to be a clonal hematological disease. Genetic aberrations typically observed in MNs are detected in approximately one-third of AA patients. In AA patients harboring MN-related genetic aberrations, a poor response to immunosuppressive therapy (IST) and an increased risk of transformation to MNs occurring either naturally or after IST are predicted. Approximately 10%–15% of patients with severe AA transform the disease phenotype to MNs following IST, and in some patients, leukemic transformation emerges during or shortly after IST. Phenotypic transformations between AHF and MNs can occur reciprocally. A fraction of advanced MN patients experience an aplastic crisis during which leukemic blasts are repressed. The switch that shapes the disease phenotype is a change in the strength of extramedullary inflammation. Both AHF and MNs have an immune-active bone marrow (BM) environment (BME). In AHF patients, an inflamed BME can be evoked by infiltrated immune cells targeting neoplastic molecules, which contributes to the BM-specific autoimmune impairment. Autoimmune responses in AHF may represent an antileukemic mechanism, and inflammatory stressors strengthen antileukemic immunity, at least in a significant proportion of patients who have MN-related genetic aberrations. During active inflammatory episodes, normal and leukemic hematopoieses are suppressed, which leads to the occurrence of aplastic cytopenia and leukemic cell regression. The successful treatment of underlying infections mitigates inflammatory stress-related antileukemic activities and promotes the penetration of leukemic hematopoiesis. The effect of IST is similar to that of treating underlying infections. Investigating inflammatory stress-powered antileukemic immunity is highly important in theoretical studies and clinical practice, especially given the wide application of immune-activating agents and immune checkpoint inhibitors in the treatment of hematological neoplasms.

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Clinical Characteristics and Etiological Spectrum of Pancytopenia in Pediatric Age Group: A Cross-Sectional Outlook From a Developing Country

Cited by 7 publications

References 18 publications

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Evaluation of pancytopenia based on bone marrow examination in adults in a tertiary care hospital in Islamabad.

When inflammatory stressors dramatically change, disease phenotypes may transform between autoimmune hematopoietic failure and myeloid neoplasms

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