pancytopenia in children

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

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pancytopenia in children

  1. 1. P a n c y t o p e n i a i n c h i l d r e n Safa Abdul Rhaman Shukry Gamal Abdul Hamid Hematology-Oncology Department Al-Gamhoria Teaching Hospital
  2. 2. <ul><li>☹ P a n c y t o p e n i a refers to a reduction in all three formed elements of the blood: erythrocytes, leukocytes, and platelets. </li></ul><ul><li>☹ P a n c y t o p e n i a seen in both the peripheral blood and bone marrow in most cases of bone marrow failure. </li></ul>
  3. 3. <ul><li>☹ P a n c y t o p e n i a 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. </li></ul><ul><li>. </li></ul>
  4. 4. <ul><li>☹ P a n c y t o p e n i a develops gradually. </li></ul><ul><li>☹ 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. </li></ul>
  5. 5. O b j e c t i v e s <ul><li>☼ The aim of this study to evaluate the clinical presentation and the etiological pattern of pancytopenia in children. </li></ul>
  6. 6. M a t e r i a l a n d M e t h o d s
  7. 7. M a t e r i a l a n d M e t h o d s <ul><li>⇛ This study carried out in AL-Gamhoria Teaching Hospital from 1st January to 31st December 2005 on 29 children who presented with pancytopenia. </li></ul><ul><li>⇛ Complete history was taken from all children and thorough complete examination was carried out of each of them. </li></ul>
  8. 8. M a t e r i a l a n d M e t h o d s <ul><li>⇛ 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. </li></ul><ul><li>⇛ 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. </li></ul>
  9. 9. M a t e r i a l a n d M e t h o d s <ul><li>⇛ 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. </li></ul>
  10. 10. R e s u l t s
  11. 11. R e s u l t s <ul><li>We came across 29 cases of pancytopenia. </li></ul><ul><li>Age range was <5years to15 years with male to female ratio being 1.1:1. </li></ul>
  12. 12. R e s u l t s <ul><li>Fig. 1: </li></ul><ul><li>The sex distribution : </li></ul><ul><li>✑ Out of these 29 cases 15 (51.7%) were male and 14 (48.3%) were female. </li></ul><ul><li>✑ The Maximum number of cases were found in the age group which less than 5 years. </li></ul>
  13. 13. R e s u l t s <ul><li>Fig. 2: </li></ul><ul><li>The age distribution: </li></ul><ul><li>✑ The youngest patient in this study was 3month old while the oldest patient was 15 years old. </li></ul><ul><li>✑ About 68.8% of cases fall in the age groups of <5years. </li></ul>
  14. 14. R e s u l t s <ul><li>☹ The various clinical presentations were fever (96.6%), splenomegaly (93.1%), pallor (86.7%) and hepatomegaly (58.6%) </li></ul><ul><li>signs of bleeding and skin rash [petechia] (27.6% . ( </li></ul>
  15. 15. Table[1]: Clinical Features of Patients presenting with pancytopenia 6.9 2 Gum Hypertrophy and oral ulcer, Bone Pain 13.8 4 Night sweat 20.7 6 Lymph node enlargement 27.6 8 Skin rach and bleeding 31.0 9 Dizziness 48.3 14 Fatigue 51.7 15 Loss of weight 58.6 17 Hepatomegaly 86.7 ➣ 26 Pallor 93.1 ➣ 27 Splenomegaly 96.6 ➣ 28 Fever % Frequency Signs and symptoms
  16. 16. R e s u l t s Table[2]: Causes of pancytopenia in children diagnosed by bone marrow examination 1 Drug induced pancytopenia 2 Acute leukemia 2 Aplastic Anemia 2 Hypersplenism 3 Kala-azar and Malaria 4 Malaria 15 Kala-azar No. of cases Causes of pancytopenia
  17. 17. R e s u l t s <ul><li>☹ 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% . </li></ul>
  18. 18. R e s u l t s Fig. [3] The relation between age and causes of pancytopenia :
  19. 19. R e s u l t s Fig.[4] The relation between sex and causes of pancytopenia :
  20. 20. D i s c u s s i o n
  21. 21. D i s c u s s i o n <ul><li>⇨ There has been little systematic study of the clinical spectrum of pancytopenia and the optimal diagnostic approach to pancytopenia remain undefined. </li></ul>
  22. 22. D i s c u s s i o n <ul><li>⇨ 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. </li></ul><ul><li>⇨ 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. </li></ul>
  23. 23. D i s c u s s i o n <ul><li>⇨ Pancytopenia is usually caused by bone marrow replacement or failure but is sometimes consequent on splenic pooling or peripheral destruction of mature cells. </li></ul><ul><li>⇨ 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. </li></ul><ul><li>. </li></ul>
  24. 24. D i s c u s s i o n <ul><li>⇨ 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. </li></ul>
  25. 25. D i s c u s s i o n <ul><li>⇨ 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. . </li></ul>
  26. 26. C o n c l u s i o n
  27. 27. C o n c l u s i o n <ul><li>✔ The most common clinical presentation is fever, splenomegaly followed by pallor and hepatomegaly. </li></ul><ul><li>✔ Visceral leishmaniasis and malaria are the most common causes of pancytopenia in children. </li></ul><ul><li>✔ Bone marrow examination is strongly mandatory diagnosis of pancytopenia. </li></ul><ul><li>✔ Focusing on detection of pancytopenia cause help in prepare treatment of pancytopenia . </li></ul>
  28. 28. R E C O M M E N D A T I O N
  29. 29. R E C O M M E N D A T I O N <ul><li>☼ Improvement quality of heath care in endemic area with malaria and leishmaniasis </li></ul><ul><li>☼ Improvement diagnostic technique “Laboratories” in rural and urban </li></ul><ul><li>☼ Early and proper diagnosis and treatment and early referring to specialized centers </li></ul>
  30. 30. THANK YOU  

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