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Clinicopathological features of pancytopenia in adults and the role of bone marrow study in etiological categorization: A one-year cross-sectional study

Background and Objectives: Pancytopenia is a combination of anemia (with a reduction of the red blood cell count), leukopenia, and thrombocytopenia. Leukopenia is usually mainly due to a reduction in the neutrophil count although the number of other granulocytes, monocytes, and lymphocytes are often also reduced. Pancytopenia is a manifestation of many serious and life-threatening diseases. This study was undertaken to evaluate the clinicopathological features of pancytopenia and the role of bone marrow study for etiological categorization. Settings and Design: This is a cross-sectional observational study conducted in a tertiary referral center of north east India, for a period of 1 year (from August 2020 to July 2021). Materials and Methods: Proper history taking and clinical examination were done for all patients attending with hemoglobin <10 mg/dL, total leukocyte count <3000 cells/cmm, and platelet count <1 lakh/cmm. The investigations done were peripheral blood smear examination with Leishman stain, special staining, as well as specific biochemical and radiological investigations as per requirement in cases; bone marrow aspiration (under all aseptic precaution); and bone marrow trephine biopsy (under all aseptic precaution). The results are presented in tables and compared with similar studies. Results: A total of 42 cases of pancytopenia were evaluated. The age group of 18–20 years was the most commonly affected. Male-to-female ratio was 1.33:1. All the patients presented with generalized weakness and pallor, and a large portion also with abdominal discomfort, hepatomegaly, and splenomegaly. Anisocytosis and macrocytosis were the most common peripheral blood smear findings. Vitamin B12 level was decreased in 75% of all the evaluated cases (15 of 20 cases). Bone marrow was hypercellular in most of the cases (80.95%) followed by hypocellular marrow (14.29%). Megaloblastic erythroid hyperplasia was the most common abnormality found in bone marrow. Megaloblastic anemia was the most common etiology followed by hypoplastic/aplastic anemia. A significant portion (7.14%) also showed bone marrow involvement by myeloma. One case of involvement by metastatic tumor was found. Conclusions: Most cases of pancytopenia were due to megaloblastic anemia and so easily curable. The bone marrow study is essential to evaluate a case of pancytopenia to know the exact etiology for proper management.