title: Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach.
abstract: BACKGROUND
  There has been little systematic study on the clinical spectrum of pancytopenia. This study was done to describe the etiology, presentation and outcome of patients with pancytopenia presenting in a general medical ward.
  
  
  METHODS
  Hundred patients with pancytopenia were included in the study from October 2001 to October 2002. Patients on cancer chemotherapy were excluded. Blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods.
  
  
  RESULTS
  In all cases, megaloblastic anemia constituted the largest group (n = 39), and also seen in conjunction with hemolytic anemia and septicemia. Hypersplenism secondary to portal hypertension (cirrhosis) was the second most common diagnosis (n = 19). Aplastic anemia, septicemia and myelodysplasia were other common causes. Two patients were the suspected cases of viral hemorrhagic fever. Thirteen (13%) patients expired. Absolute neutrophil count (ANC) less than 500/microliter was seen in 14 (14%) patients, among which 6 (15.3%) had megaloblastic anemia, 3 (37.5%) had aplastic anemia, and 2 (40%) had myelodysplasia. Eleven patients with platelet counts < or = 10 x 10(9)/L, 6 (54.5%) presented with bleeding; and 2 of these 8 had aplastic anemia and 1 patient with megaloblastic anemia. MCV values > 100 fL and > 110 fL were more frequent in patients with megaloblastic anemia with most prominent anisopoikilocytosis, microcytosis and fragmented RBCs. Macrocytosis was noted in 35 (89.7%) patients with megaloblastic anemia and 12 (63.1%) with hypersplenism, 4 (50%) with aplastic anemia. Hypersegmented neutrophils were noted in the blood films of 36 (92.3%) patients with megaloblastic anemia.
  
  
  CONCLUSIONS
  Megaloblastic anemia, hypersplenism and aplastic anemia are the common causes of pancytopenia in our study.
authors.affiliation: Medical Unit II, Holy Family Hospital, Rawalpindi. osama@pakmedinet.com
authors.forename: Osama
authors.initials: O
authors.lastname: Ishtiaq
authors.forename: Haider Z
authors.initials: HZ
authors.lastname: Baqai
authors.forename: Faiz
authors.initials: F
authors.lastname: Anwer
authors.forename: Nisar
authors.initials: N
authors.lastname: Hussain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000741:Anemia, Aplastic / Q000150:complications; D000749:Anemia, Megaloblastic / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000150:complications; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000175:diagnosis* / Q000209:etiology