الفهرس 
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Abstract
Pancytopenia is the reduction of two or all three cellular elements of peripheral blood leading to anemia, leukopenia and/or thrombocytopenia. The causes of pediatric pancytopenia vary significantly among different countries, e.g., aplastic anemia was the commonest cause in Pakistan, megaloblastic anemia in India, and infections in the USA. There are no published studies on pediatric pancytopenia in Egypt, so we conducted this study to describe the epidemiology of pancytopenia in AUCH.
We included 91 children who presented to AUCH with pancytopenia during the period from 1st November 2019 to 31st December 2020. Their median age was 24.1 months. Pallor was the commonest clinical finding (78%), followed by fever (67%) and tachycardia (47.3%). Other common findings were bleeding, hepatosplenomegaly, and lymphadenopathy.
Anemia was the commonest cytopenia (95.6%), followed by thrombocytopenia (91.2%) and neutropenia (38.5%). Normocytic normochromic anemia was the commonest type of anemia, followed by microcytic hypochromic anemia, while macrocytic anemia was uncommon.
Infections were the commonest trigger of pancytopenia, of which non-specific viral infection was the commonest (41.8%). Routine virology studies were not so informative in the diagnosis of pancytopenia. The yield of the ultrasound abdomen was limited as it didn’t provide any additional information, other than the confirmation of hepatosplenomegaly, which was already detected by clinical examination. The bone marrow was hypercellular in 42.6% of patients, normocellular in 38.9%, and hypocellular in 18%.
Regarding final diagnosis, acute leukemia was the commonest cause of pancytopenia (29.7%), followed by infections (25.3%) and concomitant IDA and ITP (10.9%). Megaloblastic anemia was rare (1.1%). One patient remained undiagnosed till the end of the study.
Treatment of pancytopenia was supportive transfusions, plus treatment of the cause, e.g., chemotherapy in leukemia, antibiotics in bacterial infections, and corticosteroids in ITP. Regarding supportive transfusions, packed RBCs were administered in 64.8% of patients, platelets were administered in 27.5% and plasma in 19.8%.
Regarding the outcome of pancytopenia, 27.5% recovered, 49.5% are living on treatment, and 23.1% died. The most common cause of death was infection (15 patients, 71.4%). The median survival of all patients was 227 days.
Admission in PICU was associated with increased mortality rather than admission in the ward. The following clinical manifestations were associated with increased mortality: toxic look, tachycardia, tachypnea, hypotonia, and developmental delay.
The following laboratory results were associated with increased mortality: elevated BUN, creatinine, AST, prolonged PT and PTT, hypoalbuminemia, hyperferritinemia, and neutrophilia, while neutropenia was associated with improved survival. Plasma, dexamethasone, and cyclosporine administration were associated with increased mortality. Iron deficiency anemia was associated with better survival, while HLH was associated with increased m