Vijayashree Thyagaraj1, Ashwin Kulkarni2, Anil Kumar T3, Ashwini N. G4
Pancytopenia is a common problem in clinical practice. Pancytopenia is defined as haemoglobin less than 9 gm/dL, total leucocyte count less than 4,000/dL and platelet count less than 1 lakhs/dL. Causes of pancytopenia vary from nutritional deficiencies, bone marrow failure status and malignancies. Pancytopenia is a common problem in geriatric population also. In this study, we try to find common causes of pancytopenia in geriatric population in a tertiary care hospital.
MATERIALS AND METHODS
40 consecutive patients who are more than 60 years of age attending General Medicine Outpatient Department were included in the study. Pancytopenia due to acute infections like viral fever and sepsis were excluded. Patients suspected to be having malignancies like lymphadenopathy and hepatosplenomegaly were also excluded. These patients were subjected to detailed history taking and clinical examination. Routine investigations like complete blood count, peripheral smear, reticulocyte count, Coombs test, serum cobalamin levels, renal function tests and liver function tests were done. Bone marrow examination was done in cases where indicated. Upper gastrointestinal endoscopy and anti-intrinsic factor antibody and antiparietal cell antibody were done where indicated.
Out of 40 patients included in the study, 25 were males and 15 were females. 28 patients were aged between 60-70 years, 10 patients between 70-80 years and 2 were more than 80 years old. Mean age of the patients was 68 years. Fatigue was the most common symptom (70%), fever was seen in 15% cases, mild cognitive impairment was reported in 10% patients and bleeding manifestations were seen in 5% cases. Most common cause of pancytopenia was cobalamin deficiency (60%). Others causes were aplastic anaemia (7.5%), chronic liver disease (5%), myelodysplasia (5%), drug induced (2.5%) and HIV associated (2.5%) cases. In this study, we saw that most common of pancytopenia was cause of cobalamin deficiency. We found that mean MCV was 88 fL (p=0.2) in all these patients.
Vitamin B12 deficiency is the most common cause of pancytopenia in elderly population. Symptoms of vitamin B12 deficiency maybe vague in elderly. High index of suspicion is required for the diagnosis. Mean corpuscular volume may not be raised in all cases. Hence, all patients in geriatric population presenting with must be tested for vitamin B12 deficiency.