Evaluation of pancytopenia in adults through haematological parameters and bone marrow studies

Introduction: Pancytopenia, simultaneous presence of anemia, leucopenia and thrombocytopenia, is a common clinical entity that we see in day to day practice Proper diagnostic evaluation requires detailed clinical history, physical examination and haematological assessment including careful peripheral blood smear examination and bone marrow evaluation. Materials and Methods: A total of 80 adult patients with pancytopenia/bicytopenia presenting between January 2016 to January 2017 were included in the study. All patients underwent detailed clinical history and physical examination. Careful peripheral blood smear examination, CBC and bone marrow aspirate was done in all. Bone marrow biopsy was done wherever feasible. Results: Megaloblastic anemia was the commonest cause of pancytopenia/bicytopenia making up 37.5% of all cases followed by erythroid hyperplasia (20%), aplastic anemia (10%). Haematological malignancies accounted for 23.75% cases of the total. Bone marrow biopsy aided in the diagnosis of 8 cases (6 cases of aplastic anemia and two cases of dry tap) while in others it was concordant with aspiration findings. Conclusion: Bone marrow aspiration and biopsy are an important adjunct to peripheral smear examination for evaluation of cytopenias. Bone marrow trephine biopsy is helpful in cases of dry tap. We also conclude that there is high prevalence of megaloblastic anemia due to nutritional deficiency among young population. Hence, this age range should be the prime target for education regarding proper dietary habits, the remediation of which might reduce the clinical burden of megaloblastic anemia.