Study Of Changes Seen In Morphological Diagnosis Of Pancytopenia

Background:Morphological evaluation of bone marrow has remained the gold standard in making hematologic diagnosis since a long time,as it allows construction of a good differential diagnosis.But hematologists were still finding difficulty in making proper diagnosis because of lack of inadequate morphological study and diagnostic criteria.Till last half of 20^th century many conditions that caused pancytopenia were confused with aplastic anemia.With the development of modern method and techniques and introduction of the more improved diagnostic and classification criteria in recent years,hematologists are been able to identify and differentiate the marrow cells more accurately and precisely,as a result improvement or changes in morphological diagnosis can be seen.Aim:General:To study the changes seen in morphological diagnosis of pancytopenia among Chinese population at the Hua Shan Hospital.Specific:1) To see the difference among the most common causes of pancytopenia in past and present.2) To discuss the changes seen in the morphological diagnosis of pancytopenia in the 10 years gap time at Hua Shan Hospital affiliated to Fudan University.Materials and methods:A retrospective study of cases of pancytopenia have been carried out from the data collected from the laboratory of Hematology department of Hua Shan hospital affiliated to Fudan University,Shanghai,China,and catering mainly to the Chinese population,in the time frame of 1991-1994 and 2001-2004 years.The specimen of 296 patients in 1991-1994 and 492 patients in 2001-2004,with peripheral blood count showing pancytopenia in out-patient and in-patient ward of Hua Shan hospital were analysed.Inclusion criteria include all age groups,both sexes:male and female,peripheral blood count showing pancytopenia in Out-patient and In-patient ward of Hua Shan Hospital.Exclusion criteria include diagnosed case of malignancy and leukemia who had been receiving chemotherapy.Those not receiving chemotherapy are included in this study. Morphological diagnosis was made mainly based on recent proposal of WHO diagnostic and classification criteria.Statistical analysis and comparison of the morphological diagnosis of Pancytopenia in two time period was done.Resultsâ– In 1991-1994,we came across 296 cases of pancytopenia.Male to female ratio was 1.02:1 and the age range was 12-85 years.The median age of the patients was 42 years and the most commonly affected age group was 35-44.The median WBC count was 2500/cumm,median hemoglobin count 7.35g/dl,and median platelets count was 45, 000/cumm.Among 296 cases,44 were insufficient specimen for diagnosis and 82 specimens were cases with pancytopenia with no morphological abnormality and specific diagnosis.Among the specimens with morphological abnormality seen,the most common cause of pancytopenia was Aplastic anemia 35,20.59%followed by Hypersplenism 33,19.41%;MDS 31,18.23%;Acute leukemia 15,8.82%;Megaloblastic anemia13,7.65%and so on.â– In 2001-2004,we came across 496 cases of pancytopenia.Male to female ratio was 1:1.23 and the age range was 13-88 years.The median age of the patients was 51 years and the most commonly affected age group was 45-54 years.The median WBC count was 2400/cumm,median hemoglobin count was 8.4g/dl,and median platelets count was 47,000/cumm.Among 492 cases,87 were insufficient specimen and 175 specimens were cases with pancytopenia with no morphological abnormality.Among the specimens with morphological abnormality seen,the most common cause of pancytopenia was MDS 44, 19.13%;followed by Acute leukemia 36,15.65%;Hypersplenism 29,12.61%;Aplastic anemia 28,12.17%;Megaloblastic anemia 24,10.43%and so on.Conclusion:The increase rate of clonal or Neoplastic disease like MDS and Acute leukemia as the most common case of pancytopenia,in 2001-2004 compared to Non-Neoplastic diseases like Aplastic anemia and Hypersplenism in 1991-1994,correlates with the development of modern methods and techniques and with the improvement in diagnostic and classification criteria of hematologic diseases.