pancytopenia in children

PPaannccyyttooppeenniiaa iinn cchhiillddrreenn

Safa Abdul Rhaman Shukry

Gamal Abdul Hamid

Hematology-Oncology Department

Al-Gamhoria Teaching Hospital

☹☹ PPaannccyyttooppeenniiaa refers to a reduction in all

three formed elements of the blood:

erythrocytes, leukocytes, and platelets.

☹☹ PPaannccyyttooppeenniiaa seen in both the peripheral

blood and bone marrow in most cases of

bone marrow failure.

☹ PPaannccyyttooppeenniiaa can result from

either a failure of production of

hematopoietic progenitors with cell

death in the marrow, or the

replacement of the bone marrow by

tumor or fibrosis, or sequestration

and/or destruction of cells by the

action of antibodies; and trapping of

normal cells in overactive

reticuloendothelial system.

.

☹ PPaannccyyttooppeenniiaa develops gradually.

☹ The clinical presenting include anemia,

Leucopoenia, and thrombocytopenia and

depending on the degree and duration of

their impairment, can lead to serious

illness and death.

OObbjjeeccttiivveess

☼☼The aim of this study to evaluate

the clinical presentation and the

etiological pattern of pancytopenia

in children.

MMaatteerriiaall aanndd

MMeetthhooddss

MMaatteerriiaall aanndd MMeetthhooddss⇛ This study carried out in AL-Gamhoria

Teaching Hospital from 1st January to 31st

December 2005 on 29 children who

presented with pancytopenia.

⇛ Complete history was taken from all

children and thorough complete

examination was carried out of each of

them.

MMaatteerriiaall aanndd MMeetthhooddss

⇛ Complete blood count and blood smear were done to look for the cell count lower than the normal rang and all of three formed elements of blood.

⇛The criteria for diagnosis of pancytopenia was: hemoglobin less than 11g/dl, total leukocytes count less than 4000/cumm and platelet count less than 150.000/cumm.

MMaatteerriiaall aanndd MMeetthhooddss

⇛Bone marrow aspiration/biopsy was

examined by using Jamshidi needles

from posterior iliac crest. Trephine

biopsy was needed in 2 patients for

evaluation of bone marrow

cellularity.

RReessuullttss

RReessuullttss

We came across 29 cases of

pancytopenia .

Age range was <5years to15

years with male to female ratio

being 1.1:1.

RReessuullttss

Fig. 1Fig. 1 : :The The sexsex distributiondistribution::

✑Out of these 29 cases 15 (51.7%) were male and 14 (48.3%) were female.

✑The Maximum number of cases were found in the age group which less than 5 years.

0

5

10

15

20

25

30

35

<5years 10-15years

Male

Female

RReessuullttss

Fig. 2Fig. 2::

The The ageage distributiondistribution::

✑The youngest patient in this study was 3month old while the oldest patient was 15 years old.

✑About 68.8% of cases fall in the age groups of <5years.

0

10

20

30

40

50

60

70

<5years

20(68.8%)

4(13.8%)

5(17.1%)

RReessuullttss

☹The various clinical presentations

were fever (96.6%), splenomegaly

(93.1%), pallor (86.7%) and

hepatomegaly (58.6%)

signs of bleeding and skin rash

[petechia] (27.6%.(

Table[1]: Clinical Table[1]: Clinical Features Features of of Patients Patients presentingpresenting withwith pancytopeniapancytopenia

Signs and symptomsFrequency %

Fever➣2896.6

Splenomegaly➣2793.1

Pallor➣2686.7

Hepatomegaly1758.6

Loss of weight1551.7

Fatigue1448.3

Dizziness931.0

Skin rach and bleeding827.6

Lymph node enlargement 620.7

Night sweat413.8

Gum Hypertrophy and oral ulcer, Bone Pain 26.9

RReessuullttss

Table[2]:Table[2]:CausesCauses of of pancytopeniapancytopenia in in childrenchildren diagnoseddiagnosed by by bone bone marrowmarrow examinationexamination

Causes of pancytopenia No. of cases

Kala-azar15 Malaria4Kala-azar and Malaria3Hypersplenism2Aplastic Anemia2Acute leukemia2Drug induced pancytopenia

1

RReessuullttss

☹The most common etiology of

pancytopenia was visceral leishmaniasis

51.7% malaria for 13.8% , visceral

leishmaniasis and malaria together

were 10.3%, acute leukemia, aplastic

anemia, and hypersplenism were 6.9%,

and drug induced pancytopenia was

3.4% .

RReessuullttss Fig. [3]Fig. [3]The relation between age and

causes of pancytopenia::

0

5

10

15

20

25

30

35

40

45

50

<5y 5-10Y 10-15y

Kala-azar

Malaria

Kala-azar &Malaria

Hypersplenism

ALL

AA

Drug inducedpancytopenia

RReessuullttss

Fig.[4] Fig.[4] The relation between sex and causes of pancytopenia:

0

5

10

15

20

25

30

Male Female

Kala-azar

Malaria

Kala-azar &Malaria

Hyperspkenism

ALL

AA

Drug inducedpancytopenia

DDiissccuussssiioonn

DDiissccuussssiioonn

⇨There has been little systematic study of

the clinical spectrum of pancytopenia

and the optimal diagnostic approach to

pancytopenia remain undefined.

DDiissccuussssiioonn⇨Pancytopenia was approximate equal

between the both sexes but pancytopenia in the Rehman H et al study in pediatric department in Peshawar was more common in male than female.

⇨In this study the fever, splenomegaly, followed by pallor and hepatomegaly were the most common presentations as compared with other study where the pallor followed by fever were the common presentation.

DDiissccuussssiioonn⇨Pancytopenia is usually caused by bone

marrow replacement or failure but is sometimes consequent on splenic pooling or peripheral destruction of mature cells.

⇨ The most common causes of pancytopenia in

this study was Kala-azar followed by malaria and Kala-azar with Malaria. Hypersplenism, acute leukemia, aplastic anemia and drug induced pancytopenia were found in the descending order.

.

DDiissccuussssiioonn⇨When compared with other study note

the different causes of pancytopenia. Niazi M. et al study of pancytopenia in both adults and children where the common causes was aplastic anemia, megaloblastic anemia while Rehman H. et al reported the causes of pancytopenia was aplastic anemia followed by iron deficiency and megaloblastic anemia.

DDiissccuussssiioonn⇨Kala-azar and Malaria was the

commonest causes of pancytopenia in children and common in the age group <5 years due to the high prevalence of infectious disease in Yemen has been cited for the increased frequency of kala-azar and Malaria. .

CCoonncclluussiioonn

CCoonncclluussiioonn

✔The most common clinical presentation is fever, splenomegaly followed by pallor and hepatomegaly.

✔Visceral leishmaniasis and malaria are the most common causes of pancytopenia in children.

✔Bone marrow examination is strongly mandatory diagnosis of pancytopenia.

✔Focusing on detection of pancytopenia cause help in prepare treatment of pancytopenia.

RREECCOOMMMMEENNDDAATTIIOONN

RREECCOOMMMMEENNDDAATTIIOONN

☼ ☼ Improvement quality of heath care Improvement quality of heath care in endemic area with malaria and in endemic area with malaria and leishmaniasisleishmaniasis

☼☼ Improvement diagnostic technique Improvement diagnostic technique “Laboratories” in rural and urban“Laboratories” in rural and urban

☼☼Early and proper diagnosis and Early and proper diagnosis and treatment and early referring to treatment and early referring to specialized centersspecialized centers