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COMMENTARY
Year : 2018  |  Volume : 11  |  Issue : 6  |  Page : 519-520  

Hematological profile of patient with pancytopenia


Department of Tropical Medicine, Hainan Medical University, Haikou, China; Department of Biological Science, Joseph Ayobabalola University, Ilara-Mokin, Nigeria; Department of Community Medicine, Dr DY Patil University, Pune, Maharashtra, India; Department of Medical Science, Faculty of Medicine, University of Nis, Nis, Serbia

Date of Web Publication15-Nov-2018

Correspondence Address:
Viroj Wiwanitkit
Hainan Medical University, Haikou

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_107_18

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How to cite this article:
Wiwanitkit V. Hematological profile of patient with pancytopenia. Med J DY Patil Vidyapeeth 2018;11:519-20

How to cite this URL:
Wiwanitkit V. Hematological profile of patient with pancytopenia. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2018 Dec 19];11:519-20. Available from: http://www.mjdrdypv.org/text.asp?2018/11/6/519/245414



The publication on “Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India” is useful information in clinical hematology and clinical epidemiology.[1] Indeed, pancytopenia is an important clinical problem that is sporadically seen worldwide. There are several etiologies of this problem. To diagnose this problem, the physician usually first observed the hematological profile results showing for the extremely low numbers of blood cellular components in all three important series (erythrocyte, leukocyte, and thrombocyte series). For a diagnosis, the first step is the verification of the problem. The aberration of the hematological profiles from automated hematological analyzer in the laboratory might be from several causes including real pathology and pseudopathology. Indeed, the clinical hematology has to implement a system for laboratory quality control to verify the quality of analysis in all steps ranging from preanalytical step thorough analytical step and postanalytical step. Nevertheless, the error is usually common in preanalytical step which is the step of patient preparation and sample collection, which is usually the role of medical personnel outside the laboratory analytical unit.[2] Rechecking for confirmation of the pancytopenia problem is necessary.

In case that the pancytopenia is verified, further investigation to find the possible etiologies is required. Regarding the test, some basic common tests that can be performed include the reticulocyte count and blood smear examination to seek for the immature red blood cell and white blood cell. Indeed, if there is the hemogram in the clinical hematological analyzer report, there might be a part that shows the large unstained cell, which is the indicator for the existence of the immature cell. The immunological tests including to Coombs test are useful to investigate for any immunological disorder. Additional toxicological test is also indicated if there is any patient's clinical history of exposure to toxic substance. The invasive test on bone marrow examination should be the next step. The nonspecific bone marrow finding might be derived from bone marrow biopsy and interpretation. Weinzierl and Amber suggested that this problem is common and the follow-up with repeated biopsy for reexamination is required.[3] Gayathri and Rao noted that the bone marrow examination is the way to get the final diagnosis of the patients with the problems of pancytopenia.[4] The investigation for the etiology in the case with pancytopenia is very important since a number of cases with pancytopenia have the underlying malignancy etiology, especially for leukemia.[3] The leukemia is proven to be an important cause of pancytopenia in pediatric patients.[3] Clinically, the pediatric case with pure pancytopenia (three blood series affected) has lower trend to have underlying malignancy comparing to those with only bicytopenia (two blood series affected).[5] Naseem et al. also found that the cases with bicytopenia usually have higher rate of positive results from physical examination (such as splenomegaly and lymphadenopathy) and lower incidence of bleeding problems.[5] Focusing on the adult case, the malignancy is also an important problem underlying pancytopenia.[3] A study by Devill et al. showed that 64% of the cases have underlying clonal diseases, especially for myeloid disorders processes.[6] For the nonclonal diseases, the commonly identified etiologies include aplastic anemia, megaloblastic anemia, and human immunodeficiency virus infection.[6] In developing countries, the infectious etiologies, especially for tuberculosis become important underlying pathologies.[7] Finally, in some extremely rare condition, the final diagnosis might not be successfully derived despite complete investigation and this condition is called “idiopathic fatal pancytopenia.”[8]



 
  References Top

1.
Varma A, Lokwani P, Malukani K, Gupta S, Maheshwari P. Study of hematological profile of adults presenting with pancytopenia in a tertiary care hospital of central India. Med J DY Patil Vidyapeeth 2018;11:512-8.  Back to cited text no. 1
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2.
Wiwanitkit V. Types and frequency of preanalytical mistakes in the first Thai ISO 9002:1994 certified clinical laboratory, a 6-month monitoring. BMC Clin Pathol 2001;1:5.  Back to cited text no. 2
    
3.
Weinzierl EP, Arber DA. Bone marrow evaluation in new-onset pancytopenia. Hum Pathol 2013;44:1154-64.  Back to cited text no. 3
    
4.
Gayathri BN, Rao KS. Pancytopenia: A clinico hematological study. J Lab Physicians 2011;3:15-20.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Naseem S, Varma N, Das R, Ahluwalia J, Sachdeva MU, Marwaha RK, et al. Pediatric patients with bicytopenia/pancytopenia: Review of etiologies and clinico-hematological profile at a tertiary center. Indian J Pathol Microbiol 2011;54:75-80.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Devitt KA, Lunde JH, Lewis MR. New onset pancytopenia in adults: A review of underlying pathologies and their associated clinical and laboratory findings. Leuk Lymphoma 2014;55:1099-105.  Back to cited text no. 6
    
7.
Rangaswamy M, Prabhu, Nandini NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc 2012;110:560-2, 566.  Back to cited text no. 7
    
8.
Goyal H, Tilak V. Idiopathic fatal pancytopenia: A Case report. J Clin Diagn Res 2016;10:ED09-11.  Back to cited text no. 8
    




 

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