ETIOLOGICAL SPECTRUM OF PANCYTOPENIA IN CHILDREN BASED ON BONE MARROW FINDINGS

Abstract

Background: Pancytopenia is a severe childhood hematological disease that involves the reduction in number of red blood cells, white blood cells and platelets. The causes can be benign nutritional deficiencies to life-threatening cancers. Bone marrow examination is important for diagnosis and management. Objective: To determine the etiological spectrum of pancytopenia in pediatric patients through bone marrow examination, identifying the prevalence of various underlying causes causing pancytopenia at Lady Reading Hospital-Medical Teaching Institution, Peshawar.

Methods: In this cross-sectional study, we reviewed the records of children (1-14 years) with pancytopenia presenting to the Pediatric Department of Lady Reading Hospital-Medical Teaching Institution, Peshawar, during March 2025 to June 2025. We took consecutive samples of 120 children (1-14 years) with pancytopenia. They were evaluated clinically and subjected to complete work-up including bone marrow aspiration and/or biopsy. The causes were classified based on the marrow morphology and cellularity.

Results: The most common causes of pancytopenia were aplastic anemia (32-38%), megaloblastic anemia (18-24%) and acute leukemia (15-20%). Infections (10-15%), myelodysplastic syndrome (5-8%) and hypersplenism (3-6%) were also common. Aplastic anemia was found more frequently in patients with aplastic marrow, whereas megaloblastic anemia and leukemia were more frequent in patients with hypercellular marrow. Age was significantly associated with the causes (p<0.05).

Conclusion: Aplastic anemia and megaloblastic anemia are the most common causes of pancytopenia in children in our region. Bone marrow examination remains important for early diagnosis and management. We need to know more about local data to inform diagnostic work up to reduce morbidity.