Clinical Analysis Of Characteristics And Etiology Of Children With Pancytopenia

【objectives】Pancytopenia is an important warning of some serious and even life-threatening diseases.The diagnosis process is complex.In clinical practice,careful differential diagnosis and long-term follow-up after treatment are often needed to make a final diagnosis.Because the treatment and treatment plan need to be adjusted according to the specific clinical situation,the etiology analysis is particularly important.Through the study of the clinical characteristics and etiology of pancytopenia,we can deepen the understanding of the syndrome contained in it,improve the level of diagnosis,in order to intervene it earlier and improve its long-term prognosis.The purpose of this study is to explore the diagnosis of pancytopenia in children by analyzing the clinical【Methods】119 subjects were selected from the Department of Hematology of Tianjin Children’s Hospital from January 2013 to December 2019,all of whom met the diagnostic criteria of pancytopenia and agreed to the bone marrow examination.Detailed medical history inquiry,comprehensive physical examination,improvement of peripheral blood cell count examination,blood smear artificial microscope examination,bone marrow puncture and blood biochemical examination,flow cytometry,etiology examination,imaging examination,bone marrow biopsy,bone marrow flow cytometry and gene examination for some patients,and summary of the above data analysis of clinical characteristics and etiology spectrum.【Results】In our study,119 subjects were studied,including 62 male patients（52.10%）and57 female patients（47.90%）.The ratio of male to female was 1.09:1.The patients were aged from 6 months to 13 years old,36 cases from 6 months to 3 years old（30.25%）,62 cases from 3 to 6 years old（52.10%）,21 cases from 6 to 13 years old（17.65%）,with an average age of 48±8 months.The most common clinical features were paleness in 101 cases（84.87%）,asthenia in 82 cases（68.91%）,fever in 81 cases（68.07%）.54 patients（45.38%）had bleeding.The results showed that the hemoglobin count range was 21-102g/L（average 63±16g/L）,the leukocyte count range was0.67-3.68×10⁹/L（average 2.45±0.57×10⁹/L）,and the neutrophil count range was0.17-1.28×10⁹/L（average 0.70±0.32×10⁹/L）.Platelet count ranged from 2 to 96×10⁹/L（mean 43.58±35.24×10⁹/L）,reticulocyte count ranged from 0.012～0.12×10¹²/L(mean 0.043±0.038×10¹²/L).According to our study,44（36.97%）patients with pancytopenia had hypocellular bone marrow,and 75（63.03%）patients had non hypocellular bone marrow.In the study,the top three causes of pancytopenia were aplastic anemia（30/119,25.21%）,acute leukemia（24/119,22.69%）,hemophagocytic lymphohistiocytosis（11/119,9.24%）.【Conclusions】1.The etiological classification of pancytopenia is complex.Besides hematological diseases,it is also secondary to a variety of non hematological diseases.A full understanding of its clinical characteristics and etiology can improve the level of diagnosis and achieve accurate treatment.2.This study shows that the most common cause of pancytopenia is aplastic anemia,which is similar to the domestic literature.3.In this study,the final diagnosis of rare diseases such as Gaucher’s disease,Fanconi’s anemia,methylmalonic acidemia and Niemann peak’s disease benefited from gene sequencing detection,and became an important detection method for the diagnosis of congenital bone marrow failure and genetic metabolic diseases.4.As there are still some limitations in the number of samples and regions,we hope to design a multi center prospective study on this issue in the future.