Pancytopenia in hospitalized children: A five-year review

Department of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN 37232-2573, USA.
Journal of Pediatric Hematology/Oncology (Impact Factor: 0.9). 07/2010; 32(5):e192-4. DOI: 10.1097/MPH.0b013e3181e03082
Source: PubMed


Pancytopenia in hospitalized children is not a common occurrence. The causes may vary in different patients and in diverse areas of the world. There are no reports in the literature describing these etiologies in a developed country. Our review focused on children presenting with pancytopenia at a children's hospital in the United States with the purpose to allow us to better evaluate and care for children.
Charts of children aged 2 months to 18 years who were admitted to our hospital over a 5-year period were retrospectively reviewed to identify the diagnosis of pancytopenia. The diagnosis of pancytopenia was confirmed by laboratory values showing neutropenia, anemia, and thrombocytopenia. These etiologies and patient characteristics were reported in our review.
A total of 64 children were identified with the diagnosis of pancytopenia. The most common diagnoses were infectious in origin (64%), followed by hematologic (28%), and miscellaneous (8%) etiologies.
The most common etiology of pancytopenia in hospitalized children without cancer was infections. This differs from earlier reports in other countries, where megaloblastic anemia was found most often. Our review should provide guidance to the diagnoses which should be considered when evaluating a child with pancytopenia.

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    • "In another study, 64 children were identified with diagnosis of pancytopenia. The most common cases were infectious in origin (64%), followed by hematological (28%) and miscellaneous (8%) etiologies.[10] "
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    ABSTRACT: Pancytopenia is a relatively common hematological entity. It is a striking feature of many serious and life-threatening illnesses, ranging from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. The severity of pancytopenia and the underlying pathology determine the management and prognosis. Thus, identification of the correct cause will help in implementing appropriate therapy. To study the clinical presentations in pancytopenia due to various causes; and to evaluate hematological parameters, including bone marrow aspiration. It was a prospective study, and 104 pancytopenic patients were evaluated clinically, along with hematological parameters and bone marrow aspiration in Hematology Unit, Department of Pathology, JJMMC, Davanagere, during the period of September 2005 to September 2007. Among 104 cases studied, age of patients ranged from 2 to 80 years with a mean age of 41 years, and male predominance. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was the predominant blood picture. Bone marrow aspiration was conclusive in all cases. The commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. The commonest cause for pancytopenia was megaloblastic anemia (74.04%), followed by aplastic anemia (18.26%). Thepresent study concludes that detailed primary hematological investigations along with bone marrow aspiration in cytopenic patients are helpful for understanding disease process and to diagnose or to rule out the causes of cytopenia. These are also helpful in planning further investigations and management.
    Journal of laboratory physicians 03/2011; 3(1):15-20. DOI:10.4103/0974-2727.78555
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    ABSTRACT: Background and aim: A study was carried out to analyze the presentation, to identify the causes and to find out the bone marrow morphology in cases of pancytopenia. Pancytopenia was an indication for bone marrow examination in 48 out of a total of 100 cases (48%) for which a bone marrow examination was requested. Methods: The data regarding the various signs and symptoms, the causes and the bone marrow findings were obtained and analyzed using simple statistical methods. All age groups were included for the study. Results: Generalized weakness (70.83%) was the commonest symptom and pallor (45.83%) was the predominant sign. Anisocytosis (79.1%) was the most important peripheral blood finding in pancytopenic patients followed by microcytosis (52.08%). The commonest cause of pancytopenia in the present study was hypoplastic marrow (33.33%), followed by normoblastic erythroid hyperplasia (27.08%), megaloblastic marrow (18.75%), and myelodysplastic syndrome (8.33%). Normal bone marrow and dry tap accounted for three cases each (6.25%). Of the various cases of myelodysplastic syndrome, one was refractory anemia; two were refractory cytopenia with multilineage dysplasia and one myelodysplastic syndrome unclassified. Dry tap was seen in three cases of pancytopenia. Bone marrow biopsy was done in one, which showed features of myelofibrosis. Conclusions: A thorough evaluation of the pancytopenic patients is necessary as it has varied causes.
    Basic and Applied Pathology 03/2012; 5(1). DOI:10.1111/j.1755-9294.2011.01121.x
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    ABSTRACT: Visceral leishmaniasis (VL, kala-azar) is caused by Leishmania spp, a parasite that is commonly encountered in Mediterranean countries. Leishmaniasis usually presents with fever, hepatosplenomegaly, lymphadenopathy, and pancytopenia. The aim of the study was to prospectively examine the characteristics of cytopenia associated with VL and compare it with other post-infectious cytopenias observed in children with febrile illnesses. We studied 112 children, aged (mean) 4.0 (SD, 3.8) years (range, 0-14 years), who were admitted to the pediatric ward because of febrile cytopenia associated with infections, during a 2-year period (March 2005 to June 2007). Study participants were investigated with measurement of acute-phase reactants, bacterial cultures, and serologic tests. Pancytopenia was detected in 9 (8%) of 112 patients (5 boys), with a mean age of 4.5 (SD, 3.0) years.The mean value of white blood cell was 3827 (SD, 1455)/mL; absolute neutrophil count, 1229 (SD, 655)/mL; hemoglobin, 8.3 (SD, 1.1) g/dL; and platelet count, 88,200 (SD, 20,186)/mL. All patients with pancytopenia had fever (mean duration, 8.9 [SD, 8.7] days) (maximum temperature, 39.5°C [SD, 0.6°C]) and hepatosplenomegaly (9/9), whereas 2 of 9 had lymphadenopathy. In these patients, a bone marrow aspiration was performed, and VL was detected in all 9 samples. They were treated with liposomal amphotericin B and had an excellent response rate. Pancytopenia resolved within a mean period of 17.6 (SD, 17.3) days (range, 8-60 days), and there was no relapse during a 2 years' follow-up. In endemic countries, leishmaniasis is the main cause of febrile pancytopenia among children in whom hematologic malignancy has been ruled out.
    Pediatric emergency care 05/2012; 28(6):533-7. DOI:10.1097/PEC.0b013e3182587d5d · 1.05 Impact Factor
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