Premkumar M, Gupta N, Singh T, Velpandian T
Department of Medicine, Maulana Azad Medical College and Associated Hospitals, Bahadur Shah Zafar Marg, New Delhi 110002, India.
Anemia. 2012;2012:707402. doi: 10.1155/2012/707402. Epub 2012 Apr 1.
Background. Pancytopenia has multiple etiologies like megaloblastic anemia, aplastic anemia, leukemia, and various infections. We investigated the clinical, etiological and hematological profile including bone marrow morphology of patients with pancytopenia in relation to their vitamin B12 and folic acid status at a tertiary care referral hospital in north India. Methods. A total of 140 consecutive patients with pancytopenia were selected from June 2007 to December 2008. Bone marrow examination and other tests were carried out as warranted, including serum cobalamin and folate assays using liquid chromatography mass spectroscopy (LC MS/MS). Results. The study population consisted of 92 males and 48 females with a mean age of 32.8 years. Megaloblastic anemia 60.7%, aplastic anemia (7.8%), and leukemia (9.2%) were common causes. Infectious causes (16.4% of all cases) included leishmaniasis, HIV-AIDS, malaria and tuberculosis. Severe cobalamin deficiency (B12 < 100 pg/mL) was seen in 81% of all patients including 91.6% of patients with MA. In contrast, only 7.14% of all pancytopenic patients were folate deficient. Folate deficiency (<5 ng/mL) was seen in just 5% MA patients. Combined cobalamin and folate deficiency was seen in 5 patients (3.51%). Conclusion. Cobalamin deficiency was found to be more common in our setting and is largely underdiagnosed in the age of folate supplementation. Infectious diseases like tuberculosis, leishmaniasis, and increasingly HIV are important and treatable causes of pancytopenia. This is in contrast with the developed nations where the bulk of disease is due to malignancy or marrow aplasia.
背景。全血细胞减少有多种病因，如巨幼细胞贫血、再生障碍性贫血、白血病及各种感染。在印度北部一家三级医疗转诊医院，我们调查了全血细胞减少患者的临床、病因及血液学特征，包括骨髓形态，并将其与维生素B12和叶酸状态相关联。方法。2007年6月至2008年12月共选取140例连续性全血细胞减少患者。根据需要进行骨髓检查及其他检查，包括使用液相色谱质谱联用仪（LC MS/MS）检测血清钴胺素和叶酸。结果。研究人群包括92例男性和48例女性，平均年龄32.8岁。常见病因包括巨幼细胞贫血（60.7%）、再生障碍性贫血（7.8%）和白血病（9.2%）。感染性病因（占所有病例的16.4%）包括利什曼病、艾滋病、疟疾和结核病。81%的患者存在严重钴胺素缺乏（B12 < 100 pg/mL），其中巨幼细胞贫血患者中该比例为91.6%。相比之下，所有全血细胞减少患者中仅有7.14%叶酸缺乏。仅5%的巨幼细胞贫血患者存在叶酸缺乏（<5 ng/mL）。5例患者（3.51%）同时存在钴胺素和叶酸缺乏。结论。在我们的研究环境中发现钴胺素缺乏更为常见，在补充叶酸的时代，该情况很大程度上未被诊断出来。结核病、利什曼病等传染病以及日益增多的艾滋病是全血细胞减少的重要且可治疗的病因。这与发达国家不同，在发达国家，大部分疾病是由恶性肿瘤或骨髓再生障碍引起的。
