Evaluation of Etiological Causes and Incidence of Pancytopenia: A Case Series from a Tertiary Care Center

TL;DR

This study identifies vitamin B12 deficiency and hypersplenism as the most common causes of pancytopenia in a Turkish patient group.

Contribution

The study provides region-specific insights into pancytopenia causes in Turkey, emphasizing non-malignant systemic conditions.

Findings

Vitamin B12 deficiency and hypersplenism were the most frequent causes of pancytopenia (20.5%).

Hematological malignancies accounted for 16% of cases, lower than expected in this region.

Abstract

Background and aim

Pancytopenia is a clinical condition characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets. It generally arises from conditions associated with bone marrow dysfunction or increased peripheral consumption of blood cells. Understanding the regional etiological models of pancytopenia is of paramount importance for optimizing diagnostic and therapeutic strategies specific to the local population. This study aimed to identify the etiological causes and examine the distribution of incidence rates in patients presenting with pancytopenia in Istanbul and cases referred from across Turkey.

Methods

This retrospective study was conducted between January 2008 and November 2010 in the general internal medicine clinic of a tertiary care training and research hospital serving a large population. The study included 112 adult patients newly diagnosed with pancytopenia who had complete clinical and laboratory data. Data were obtained through detailed laboratory analyses, diagnostic tests, and clinical evaluations.

Results

Of the 112 patients, the female-to-male ratio was 1.8:1, and the mean age was 56.5 years, with the most common age group being 70-79 years (19.6%, n=22). Pancytopenia was most frequently caused by vitamin B12 deficiency and hypersplenism (20.5%, n=23). These were followed by hematological malignancies (acute leukemia, lymphoma, and multiple myeloma) at 16% (n=18), infections and myelodysplastic syndromes at 10.7% (n=12), drug-induced pancytopenia at 5.4% (n=6), systemic lupus erythematosus at 4.5% (n=5), metastatic solid organ tumors at 3.6% (n=4), and aplastic anemia at 1.8% (n=2).

Conclusion

This study demonstrated that the most common causes of pancytopenia in the evaluated patient group in Istanbul and cases referred from across Turkey were vitamin B12 deficiency and hypersplenism. This finding underscores the importance of prioritizing systemic conditions over hematological malignancies in the diagnostic process. Accurate identification of underlying causes and improved patient management require a structured diagnostic approach involving thorough clinical evaluations and targeted investigations tailored to regional characteristics.

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