| Objective:Summarize clinical data of 416 children pancytopenia cases and analyze etiology proportion and character of pancytopenia,to provide diagnosis ideas for pediatrician.Methods:Applicating of computer medical record management system,we collected the information about the pediatric hospitalized children in our hospital from July 1,2014 to December 31,2016.And 416 children with PCP were selected,they meet the inclusion and exclusion criteria,retrospective analysis their etiologies,clinical features and laboratory indicators.Results1.General situation416 cases of PCP children,239 boys and 177 girls,aged 2 months to 16 years old,and their median age is 6 years old.2.The clinical manifestations of PCP childrenAmong the 416 cases of PCP children,there were 277 cases(66.59%)of fever,199 cases(47.84%)of hemorrhage,88 cases(21.15%)of swollen lymph nodes,125cases(30.05%)of swollen liver,73 cases(17.55%)of swollen spleen,22 cases(5.29%)of bone and joint pain,232 cases(55.77%)of infection,135 cases(32.45%)of cough,93 cases(22.36%)of poor appetite,34 cases(8.17%)of vomiting,34 cases(8.17%)of abdominal pain,Beside these,there are runny nose,fatigue,dizziness and other different performance,and different etiologies have different characteristics of performance.(1)the comparison of fever rates in neutrophil groupsIt has a certain correlation between granulocyte count and fever(r=0.137,P=0.019);The fever rate of granulocyte deficiency group is 73.37%(146/199),the fever rate of granulocytic group is 60.82%(104/171),and the fever rate of granulocyte normal group 58.70%(27/46).This difference of fever rate is statistically significant(Statistic 7.956,P=0.019);Comparing two of them,we find that granulocyte deficiency group and granulocytic group(P=0.010),granulocyte deficiency group and granulocyte normal group(P=0.049),their differences of fever rate are statistically significant;granulocytic group and granulocyte normal group(P=0.794),their difference of fever rate is not statistically significant.(2)the comparison of bleeding rates in platelet groupsIt has a certain correlation between platelet count and bleeding(r=0.384,P0 <0.001).The bleeding rate of PLT≤25×109/L group is 71.35%(122/171),the bleeding rate of PLT≤50×109/L group is 37.12%(49/132),the bleeding rate of PLT≤75×109/L group is 31.5 %(23/73),and the bleeding rate of PLT < 100×109/L group is12.5%(5/40).This difference of bleeding rate is statistically significant(Statistic71.763,P < 0.001);Comparing two of them,we find that PLT ≤ 75×109/L group and PLT ≤ 50×109/L group(P > 0.05),their difference of fever rate is not statistically significant;Differences in other groups(P < 0.05)are statistically significant.About bleeding position,there is mostly skin bleeding,also gastrointestinal bleeding and other organs bleeding.3.The etiological proportion416 cases of PCP children,There are 344 cases of blood system diseases,63 cases of non-blood system diseases and 9 cases of unexplained diseases,They accountfor 82.69%,15.15% and 2.16%.(1)The etiological proportion of hematologic diseases344(82.69% of all the pancytopenia)cases of hematologic diseases,there are162(38.94%)cases of AA,89(21.39%)cases of leukocythemia,53(12.74%)cases of HLH,16(3.84)cases of ITP,12(2.88)cases of MDS,3(0.72%)cases of MA,3(0.72%)cases of LCH,2(0.48%)cases of FA,2(0.48%)cases of Bone marrow necrosis,1(0.24%)cases of Hereditary spherocytosis hyperplasia and1(0.24%)cases of subcutaneous panniculitis like T cell lymphoma.(2)The etiological proportion of non-hematologic diseases63(15.15%)cases of non-hematologic diseases,there are 28(6.73%)cases of infectious disease,11(2.64%)cases of liver diseases,7(1.68%)cases of kidney diseases,10(2.40%)cases of autoimmune diseases(5 cases of SLE,2 cases of JIA and 3 cases other connective tissue diseases),2(0.48%)cases of NB,1(0.24%)cases of nephroblastoma,4(0.96%)cases of genetic metabolic diseases(2 cases of Gossie disease,1 case of Niemann disease and 1 case of Albers Schonberg disease).(3)Unknown etiology9(2.16%)cases of unknown etiology,they may be diagnosed as hematological malignancies,immunodeficiency diseases,infection-related diseases.4.The comparison of blood system diseases with non-blood system diseases(1)The blood cell’s reduction: The comparison of blood system diseases with non-blood system diseases,WBC count conforms to homogeneity of variance(F=0.100,P=0.752),the difference of their mean is not statistically significant(P=0.496);Amount of hemoglobin conforms to homogeneity of variance(F=0.433,P=0.511),the hemoglobin of blood system diseases are less and this difference is statistically significant(P < 0.001);PLT count doesn’t conform to homogeneity of variance(F=10.280,P=0.001),the PLT count of blood system diseases are less and this difference is statistically significant(P<0.001).(2)Blood cell reduction index: mild,moderate,severe,very severe.On the reduction degree of leukopenia,the difference is not statistically significant(P=0.432);On the reduction degree of hemoglobin,the difference is statistically significant(P=0.009);On the reduction degree of PLT,the difference is statisticallysignificant(P<0.001).5.The comparison of AA、AL、HLH and infectious disease(1)In the 6 months to 6 years old group and 6 to 16 years old group,AA,AL,HLH and infectious disease have different age distribution(Chi square value=27.250,P<0.001).Comparing two of them,we find that AA and AL(Chi square value=5.357,P=0.021),AA and HLH(Chi square value=20.892,P <0.001),AL and HLH(Chi square value= 6.120,P=0.013),AA and infectious disease(Chi square value=11.279,P=0.001)all had different distribution in two age groups.(2)About their WBC count 、 amount of hemoglobin and PLT count,the differences of their mean is statistically significant(P<0.05).Comparing two of them,we find that :about WBC count,AA and HLH 、 AL and HLH,their difference is statistically significant(P<0.05);about amount of hemoglobin,AA and AL、AA and HLH、AA and infectious disease、HLH and infectious disease、AL and infectious disease,their difference is statistically significant(P<0.05);about PLT count,AA and AL、AA and infectious disease、 HLH and AL 、HLH and infectious disease,their difference is statistically significant(P<0.05).(3)Blood cell reduction index: mild,moderate,severe,very severe.On the reduction degree of leukopenia,their difference is statistically significant(H=14.886,P=0.002).Comparing two of them,the difference of AA and AL(P=0.792),AA and infectious disease(P=0.336),AL and infectious disease(P=0.398),HLH and infectious disease(P=0.167)are not statistically significant;the difference of AL and HLH(P=0.001),AA and HLH(P<0.001)are statistically significant.On the reduction degree of hemoglobin,the difference of them is statistically significant(H=31.328,P < 0.001).Comparing two of them,the difference of AL and HLH is not statistically significant(P=0.375);the difference of AA and AL(P=0.006),AA and HLH(P=0.003),AA and infectious disease(P < 0.001),AL and infectious disease(P < 0.001),HLH and infectious disease(P < 0.001)are statistically significant.On the reduction degree of PLT,the difference of them is statistically significant(H=57.439,P < 0.001).Comparing two of them,the difference of AA and HLH(P=0.678),AA and infectious disease(P=0.735)is not statistically significant;the difference of AA and AL(P < 0.001),AL and HLH(P < 0.001),ALand infectious disease(P < 0.001),HLH and infectious disease(P=0.002)are statistically significant.(4)For the disease has been submitted to LDH,24.6% of AA 、 59.6% of AL 、100% of HLH、83.4% of infectious disease,their LDH increased in varying degrees.About the LDH,the difference of AA、AL、HLH and infectious disease is statistically significant(H=131.941,P < 0.001);Comparing two of them,the difference of AL and infectious disease is not statistically significant(P=0.532);The difference of AA and AL(P<0.001)、AA and HLH(P<0.001)、AA and infectious disease(P=0.041)、AL与 HLH(P<0.001)、HLH and infectious disease(P=0.022)are statistically significant.(5)For the disease has been submitted to ferritin,88.9%of AA、100% of AL、100% of HLH、81.25%of infectious disease,their ferritin increased in varying degrees.About the ferritin,the difference of AA 、 AL 、 HLH and infectious disease is statistically significant(H=63.522,P < 0.001);Comparing two of them,the difference of AA and AL(P=0.258)、 AA and infectious disease(P=1.000)、 AL and infectious disease(P=0.849)is not statistically significant;The difference of AA and HLH(P <0.001)、 AL 与 HLH(P < 0.001)、 HLH and infectious disease(P < 0.001)are statistically significant.(6)Most of the disease’s bone marrow is consistent with its typical bone marrow features.About AA、AL、HLH,It has a certain correlation between the degree of bone marrow hyperplasia and disease types(r=0.274,P=0.001);This difference of the degree of bone marrow hyperplasia is statistically significant(Chi square value=26.392,P < 0.001);Comparing two of them,their difference of AA and AL(P=0.000),AA and HLH(P=0.001),AA and infectious disease(P=0.004)is statistically significant;their difference of AL and HLH(P=0.894),AL and infectious disease(Correction method,P=0.593),HLH and infectious disease(Correction method,P=0.577)is not statistically significant.6.Analysis of MCV,MCH,MCHC,RDW in several diseasesHLH and infectious diseases show small cell anemia,there is no obvious change in other indicators.In this study,there were only 3 cases of MA,but all of them show typical large cell anemia.AA is mostly normal size cells or large cell anemia.According to MCV and RDW,there are significant heterogeneity of anemia inMDS 、 infectious diseases and liver disease,while anemia of ITP is relatively high homogeneity.7.Comparison of the bone marrow hyperplasia between bone marrow biopsy and Bone marrow smearA total of 174 children underwent bone marrow biopsy and bone marrow smear,in bone marrow biopsy,hyperplasia of 77.6% is reduced,While hyperplasia of 41.4%is reduced in bone marrow smear.their difference of bone marrow hyperplasia(P <0.001)is statistically significant;That is to say,Bone marrow biopsy is more likely to found myeloproliferation decreased.8.In kidney disease,the correlation of hemoglobin and BUN,CREAIn 7 kidney disease cases,it has linear correlation between hemoglobin and BUN(the correlation coefficient 0.931,P=0.002);it has linear correlation between hemoglobin and CREA(the correlation coefficient 0.891,P=0.007);Combined with scatter plot,we can know that there is a negative correlation between BUN 、CREA and hemoglobin.9.In liver disease,the correlation of hemoglobin and ALBIn 11 liver disease cases,it has linear correlation between hemoglobin and ALB(the correlation coefficient 0.831,P=0.002);Combined with scatter plot,we can know that there is a positive correlation between ALB and hemoglobin.Conclusion(1)There are many causes of children PCP,mainly composed of two categories:blood system diseases and non-blood system diseases.The more common reasons of blood system diseases are AA,AL and HLH.Non-blood system diseases include:infectious,liver disease,kidney disease,autoimmune diseases,solid tumors and genetic metabolic diseases.(2)When we found the PCP children,we should combine clinical manifestations and signs,from the degree of reduction of blood cells to determine the general cause: the reduction of blood cell in blood system diseases is more obvious.(3)According to the onset age of children,blood cell indicators,red blood cellmorphology,blood LDH,ferritin,bone marrow cytology and bone marrow biopsy,we can be more early,timely and accurate diagnosis and develop or adjust the appropriate diagnosis and treatment programs;AA: 6-year-old group,PLT decreased significantly,LDH normal,slightly elevated ferritin,myeloproliferation decreased,positive or large cell anemia;AL: Hb lower,PLT significantly reduced,LDH and ferritin increased slightly,myeloproliferative active,positive cell anemia;HLH: 6months-6 years old,three lines were significantly reduced,mostly Severe LDH and ferritin were significantly increased,small cell anemia;Infectious disease: 6 months-6 years old,three lines reduced lightly,LDH and ferritin higher,bone marrow hyperplasia,small cell anemia.(4)About PCP caused by liver disease in children,there was a positive correlation between anemia and ALB.About PCP caused by kidney disease in children,there was a negative correlation between anemia and CREA. |
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