Bicytopenia/pancytopenia in children - clinico etiological profile and importance of bone marrow evaluation in a tertiary care centre

Abstract

Background: Peripheral cytopenia is a common hematological problem in our day-to-day clinical practice resulting from various diseases ranging from transient infection induced bone marrow suppression to life threatening hematological malignancies. The objective of this study was to know the clinicoetiological profile,hematological analysis and importance of bone marrow evaluation of bicytopenia/pancytopenia in children in a tertiary care teaching hospital.Methods: This was a retrospective, observational study, conducted in pediatric department, NRIIMS, Visakhapatnam, Andhra Pradesh from May 2019 to May 2020. All children in the age group of 1-18yrs of age admitted with new onset bicytopenia/pancytopenia who underwent hematological analysis and bone marrow examination in our hospital were included in this study. Children with bicytopenia/ pancytopenia evaluated outside/treated in other hospitals were excluded from our study. Data was obtained from bone marrow biopsy register from pathology department, admission register of pediatric ward and hospital medical records.Results: Out of the 31 children studied, males were (54.8%), females were (45.2%).11-18 years of age were (51.6%), 1-5 years of age were (38.7%). Fever (77.4%), pallor (74.1%), hepatosplenomegaly (41%) was the most common clinical feature noted in these patients. ALL (52.3%), followed by ITP (9.52%) was the most common etiology for bicytopenia. Aplastic anaemia (40%), megaloblastic anaemia (20%) were most common etiology noted for pancytopenia. Bicytopenia (67.7%) was more common than pancytopenia (32.2%).Peripheral smear examination picked up only 11 out of 14 cases of haematological malignancy, identified by bone marrow examination. Most common bone marrow finding noted was ALL (38.7%), followed by hypocellular bone marrow (22.5%).Conclusions: When there is high index of clinical suspicion and peripheral smear is unable to pick up these cases, it is advisable to do bone marrow examination at the earliest for early confirmation.