title: Pancytopenia - (?) An obstacle in the diagnosis and outcome of pediatric acute lymphoblastic leukemia.
abstract: BACKGROUND
  Acute lymphoblastic leukemia (ALL) ranks first among pediatric malignancies. 8-12% of ALL present with pancytopenia and 2% with hypocellular marrow a. Diagnosis of ALL in the background of pancytopenia and aplastic bone marrow is difficult.
  
  
  OBJECTIVE
  This study was aimed to compare the clinicopathologic, genetic, and outcome of paediatric ALL patients with and without pancytopenia.
  
  
  METHODS
  This is a retrospective cross-sectional study.
  
  
  METHODS
  The study included all ALL patients presenting with pancytopenia. The control group included equal number of randomly selected patients with ALL without pancytopenia treated during the same period. Ethics committee approved this study. The demographic, laboratory, and treatment-related details were retrieved from the records and entered in an Excel sheet.
  
  
  METHODS
  Data was analyzed with Chi-square test with IBM SPSS statistics 16 software.
  
  
  RESULTS
  Diagnosis by peripheral smear is significantly lower (P = 0.015) in comparison with the control group. There is no significant difference in diagnosis between the groups by bone marrow aspirate (P = 0.731) and biopsy (P = 0.849). The diagnosis of leukemia is misdiagnosed as hypo cellular/aplastic marrow in 10% of the pancytopenic patients. Flow cytometry yielded the diagnosis in all the pancytopenic patients. Though cytogenetic abnormalities are more common in pancytopenic group, it is not statistically significant (P = 0.106). There is no significant difference in treatment outcome between the groups (P = 0.0827%).
  
  
  CONCLUSIONS
  Clinical expertise is highly essential to evaluate a case of pancytopenia to diagnose leukemia. Pancytopenia is an obstacle in the diagnosis of ALL without immunophenotyping. There is no significant difference in the outcome between the two groups.
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Shruti
authors.initials: S
authors.lastname: Raja
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Febe Renjitha
authors.initials: FR
authors.lastname: Suman
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Julius Xavier
authors.initials: JX
authors.lastname: Scott
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Latha
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Aruna
authors.initials: A
authors.lastname: Rajenderan
authors.affiliation: Department of Pathology and Paediatric Haematology Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Abhirami
authors.initials: A
authors.lastname: Ethican
keywords: Acute lymphoblastic leukemia; flow cytometry; pancytopenia; pediatric acute lymphoblastic leukemia