Alpert Naomi, Rapp Joseph L, Mascarenhas John, Scigliano Eileen, Tremblay Douglas, Marcellino Bridget K, Taioli Emanuela
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Front Oncol. 2020 Nov 20;10:579075. doi: 10.3389/fonc.2020.579075. eCollection 2020.
Cytopenia, a reduced count of blood cells manifesting as anemia, neutropenia, and/or thrombocytopenia is frequently associated with other medical conditions. However, a cytopenia may not be accompanied by a known determinant and in some of these cases, may be a precursor to pre-malignancies or hematologic cancers. Little is known about the prevalence of these unexplained cytopenias and their distribution in the population.
The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2002 was used to identify those with a cytopenia in the general population. Those without an identifiable determinant in the NHANES were classified as having unexplained cytopenia. Weighted frequencies were examined to assess the prevalence of unexplained cytopenia in the population. Distribution of blood counts comparing those with unexplained cytopenia to the general population was examined. Multivariable logistic regression was conducted to assess the association between unexplained cytopenia and demographic factors.
Of the 7,962 people in the sample, 236 (2.0%) had any cytopenia and 86 (0.9%) had an unexplained cytopenia. Approximately 43% of all cytopenias were not accompanied by a clinical determinant. Unexplained cytopenia was more common in men (1.1%) than in women (0.7%) and in Non-Hispanic Black participants (3.4%). Among those with an unexplained cytopenia, the majority (74.8%) manifested as neutropenia. Compared to those with no cytopenia, those with unexplained cytopenia were significantly less likely to be female, have body mass index ≥30 kg/m, and work in the service industry, and were significantly more likely to be non-Hispanic Black.
This is the first study to examine the prevalence of unexplained cytopenia in a nationally representative sample and may serve as a baseline for comparison with other populations. Future research to identify risk factors for development of malignant hematological disorders among those with unexplained cytopenia is warranted.
血细胞减少症表现为贫血、中性粒细胞减少和/或血小板减少，血细胞计数降低，常与其他疾病相关。然而，血细胞减少症可能没有已知的决定因素，在某些情况下，可能是癌前病变或血液系统癌症的先兆。关于这些不明原因的血细胞减少症的患病率及其在人群中的分布情况，人们知之甚少。
利用1999年至2002年的美国国家健康与营养检查调查（NHANES）来确定普通人群中患有血细胞减少症的人。在NHANES中没有可识别决定因素的人被归类为患有不明原因的血细胞减少症。检查加权频率以评估人群中不明原因血细胞减少症的患病率。比较了不明原因血细胞减少症患者与普通人群的血细胞计数分布情况。进行多变量逻辑回归以评估不明原因血细胞减少症与人口统计学因素之间的关联。
在样本中的7962人中，236人（2.0%）患有任何血细胞减少症，86人（0.9%）患有不明原因的血细胞减少症。所有血细胞减少症中约43%没有临床决定因素。不明原因的血细胞减少症在男性（1.1%）中比女性（0.7%）和非西班牙裔黑人参与者（3.4%）中更常见。在患有不明原因血细胞减少症的人中，大多数（74.8%）表现为中性粒细胞减少。与没有血细胞减少症的人相比，患有不明原因血细胞减少症的人女性比例显著较低，体重指数≥30 kg/m²的可能性较小，在服务业工作的可能性较小，而非西班牙裔黑人的可能性显著更高。
这是第一项在全国代表性样本中研究不明原因血细胞减少症患病率的研究，可作为与其他人群进行比较的基线。有必要进行未来研究，以确定不明原因血细胞减少症患者发生恶性血液系统疾病的危险因素。
