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the most common cause of pancytopenia in children was LD bodies and malaria
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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