Clinicopathological profile of pancytopenia in adult patients attending a tertiary care hospital: a hospital-based cross-sectional study.

Narendra Kumar Chandrashekar; Thiragati Venu Gopala Krishna; Kandanala Mallika; Dr Anand  Acharya

doi:10.51168/sjhrafrica.v7i2.2728

Autori

Narendra Kumar Chandrashekar Associate Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Thiragati Venu Gopala Krishna Assistant Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Kandanala Mallika Associate Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Dr Anand Acharya Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2728

Cuvinte cheie:

Adult pancytopenia, Bone marrow examination, Megaloblastic anaemia, Aplastic anaemia, Peripheral smear, Tertiary care hospital

Rezumat

Background

Pancytopenia is a clinically important haematological presentation characterized by simultaneous reduction of erythrocytes, leukocytes and platelets. Its causes range from reversible nutritional deficiency to marrow failure and haematological malignancy.

Objectives

To evaluate the clinical presentation, haematological profile, peripheral smear findings, bone marrow patterns and etiological spectrum of pancytopenia in adult patients.

Methods

This hospital-based cross-sectional study was conducted among 100 adult patients with pancytopenia at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, from September 2025 to February 2026. Adult patients fulfilling haematological criteria for pancytopenia were evaluated using clinical history, physical examination, complete blood count, peripheral smear and bone marrow examination when indicated. Data were analysed using descriptive statistics.

Results

All 100 eligible participants were included and analysed. The mean age was 43.6 ± 16.2 years, and the largest age group was 31–45 years. Males constituted 56% of cases. Generalized weakness was the most frequent symptom, followed by fever and dyspnoea on exertion. Pallor was seen in all patients. Mean haemoglobin, total leukocyte count and platelet count were 6.8 ± 1.7 g/dL, 2,180 ± 760 cells/mm³ and 62,400 ± 28,600/mm³, respectively. Macro-ovalocytes with hypersegmented neutrophils were the commonest peripheral smear finding. Hypercellular marrow was the predominant marrow pattern. Megaloblastic anaemia was the leading etiology, followed by aplastic anaemia, hypersplenism and acute leukaemia.

Conclusion

Megaloblastic anaemia was the most common cause of adult pancytopenia in this tertiary care setting. A systematic clinicopathological approach helps distinguish treatable causes from marrow failure and malignant disorders.

Recommendations

Routine peripheral smear review, early haematinic evaluation and selective bone marrow examination are recommended for timely diagnosis and rational management.

Biografii autori

Narendra Kumar Chandrashekar, Associate Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Associate Professor in the Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. He is actively involved in undergraduate and postgraduate teaching, diagnostic histopathology, cytopathology, and academic research. His areas of professional interest include surgical pathology, clinicopathological correlation, and pathology-based observational research.
Thiragati Venu Gopala Krishna, Assistant Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Assistant Professor in the Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. He contributes to diagnostic pathology services, medical education, and research activities within the department. His academic interests include histopathology, cytology, hematology, and evidence-based laboratory medicine.
Kandanala Mallika, Associate Professor, Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Associate Professor in the Department of Pathology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. She has experience in pathology teaching, diagnostic reporting, and academic supervision. Her professional interests include surgical pathology, cytopathology, laboratory quality improvement, and clinicopathological research.
Dr Anand Acharya, Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

currently serves as Dean and Professor, Department of Pharmacology, at the Konaseema Institute of Medical Sciences & Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India. A distinguished academician, researcher, and medical education leader, he has been pivotal in transforming KIMS&RF from its formative phase into a premier medical institution with over 200 undergraduate and 100 postgraduate seats.

With more than 18 years of teaching and administrative experience, Dr. Acharya has held several leadership positions, including Vice Principal, Principal, Chief Warden, Member Secretary of Institutional Ethics and Animal Ethics Committees, and is an approved PhD Guide under Dr. NTR University of Health Sciences, Vijayawada. His visionary leadership has significantly enhanced the institution’s academic quality, clinical exposure, research infrastructure, and postgraduate training standards.

He has completed prestigious national faculty development programs such as the Revised Basic Course Workshop (rBCW), Advanced Course in Medical Education (ACME), and National Teacher Training Course (NTTC, JIPMER, Puducherry). He also serves as Coordinator for Pharmacovigilance and Materiovigilance Programs under IPC–PvPI and MoHFW, Government of India, contributing actively to national drug safety and regulatory initiatives.

A prolific academician, Dr. Acharya has authored and co-authored more than 100 scientific publications in reputed national and international indexed journals. His wide-ranging research covers toxicology, pharmacovigilance, antimicrobial resistance, endocrinology, neuropharmacology, and clinical pharmacology. His recent studies include long-term analyses of pyrethroid, paraquat, and chlorpyrifos poisoning, investigations into antimicrobial resistance trends, and predictive models for treatment outcomes in dermatological and toxicological emergencies.

Dr. Acharya’s professional interests include clinical pharmacology, toxicovigilance, rational drug use, pharmacovigilance systems, and innovations in medical education technologies. He continues to mentor numerous postgraduate and undergraduate researchers while playing an integral role in curriculum reform, ethics governance, and institutional academic advancement.ORCID iD: https://orcid.org/0009-0000-7967-9092

Referințe

Gnanaraj J, Parnes A, Francis CW, Go RS, Takemoto CM, Hashmi SK. Approach to pancytopenia: diagnostic algorithm for clinical hematologists. Blood Rev. 2018 Sep;32(5):361-367. doi:10.1016/j.blre.2018.03.001. PMID:29555368. https://doi.org/10.1016/j.blre.2018.03.001

Weinzierl EP, Arber DA. Bone marrow evaluation in new-onset pancytopenia. Hum Pathol. 2013 Jun;44(6):1154-1164. PMID:23332933 https://doi.org/10.1016/j.humpath.2012.10.006

Khunger JM, Arulselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia--a clinico haematological study of 200 cases. Indian J Pathol Microbiol. 2002 Jul;45(3):375-379. PMID:12785191.

Kumar R, Kalra SP, Kumar H, Anand AC, Madan H. Pancytopenia--a six year study. J Assoc Physicians India. 2001 Nov;49:1078-1081. PMID:11868860.

Gayathri BN, Rao KS. Pancytopenia: a clinico hematological study. J Lab Physicians. 2011 Jan;3(1):15-20. PMID:21701657. https://doi.org/10.4103/0974-2727.78555

Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. JNMA J Nepal Med Assoc. 2008 Jan-Mar;47(169):12-17. PMID:18552886. https://doi.org/10.31729/jnma.209

Rangaswamy M, Prabhu, Nandini NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc. 2012 Aug;110(8):560-562, 566. PMID:23741821.

Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital. BMC Hematol. 2013 Nov 6;13(1):10. PMID:24238033. https://doi.org/10.1186/2052-1839-13-10

Makheja KD, Maheshwari BK, Arain S, Kumar S, Kumari S, Vikash. The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci. 2013 Sep;29(5):1108-1111. PMID:24353701. https://doi.org/10.12669/pjms.295.3458

Chandra H, Gupta AK, Nath UK, Singh N, Kumar U, Kishore S. Clinico-hematological study of pancytopenia: A single-center experience from north Himalayan region of India. J Family Med Prim Care. 2019 Dec 10;8(12):3944-3948. PMID:31879641. https://doi.org/10.4103/jfmpc.jfmpc_539_19

Patel GR, Prajapati GR. Spectrum of Pancytopenia in Adults Attending a Clinical Hematology Department: A Four-Year Experience From a Tertiary Care Center of Western India. Cureus. 2022 May 12;14(5):e24933. https://doi.org/10.7759/cureus.24933

Vargas-Carretero CJ, Fernandez-Vargas OE, Ron-Magaña AL, Padilla-Ortega JA, Ron-Guerrero CS, Barrera-Chairez E. Etiology and clinico-hematological profile of pancytopenia: experience of a Mexican Tertiary Care Center and review of the literature. Hematology. 2019 Dec;24(1):399-404. PMID:30890036. https://doi.org/10.1080/16078454.2019.1590961

Tang L, Miao J, Wang J. Clinical characteristics of megaloblastic anemia with pancytopenia. Hematology. 2024 Dec;29(1):2420407. https://doi.org/10.1080/16078454.2024.2420407

Aslinia F, Mazza JJ, Yale SH. Megaloblastic anemia and other causes of macrocytosis. Clin Med Res. 2006 Sep;4(3):236-241. PMID:16988104. https://doi.org/10.3121/cmr.4.3.236