New Onset Pancytopenia in Adults: Review of Underlying Pathologies and Associated Clinical and Laboratory Findings.
Katherine A Devitt, John H Lunde, Michael R Lewis. University of Vermont, Burlington
Background: Pancytopenia is frequently encountered in hematology practice; there exist few published assessments of the frequencies of various etiologies, and review of this literature reveals considerable geographic variation. We have reviewed cases of new onset pancytopenia in adults to determine the most common etiologies and to identify associations with clinical and laboratory findings.
Design: Bone marrow specimens from pancytopenic adults received over a 7-year period (7/1/02-6/30/09) were reviewed. Pancytopenia was defined by anemia (Hb < 11.6/13.8 g/dl in women/men), thrombocytopenia (platelets < 141,000/cmm), and leukopenia (WBC < 4000/cmm). Exclusion criteria included prior diagnosis of hematolymphoid neoplasm, prior bone marrow study for pancytopenia, and recent treatment (<6 mos) with cytotoxic chemotherapy, leaving 132 cases (M:F=81:51; median age 63.5y, range 20-87).
Results: 84/132 cases (64%) had clonal etiologies. Most common were myeloid processes; the 34 cases of AML (26%) included AML with myelodysplasia-related changes (7%) and acute promyelocytic leukemia (4%). 23 cases of myelodysplasia (17%) included predominantly refractory anemia with excess blasts (8%) and refractory cytopenia with multilineage dysplasia (5%). Less common were lymphoid neoplasms such as non-Hodgkin lymphomas (6%), hairy cell leukemia (5%), precursor B ALL (4%), and plasma cell dyscrasias (3%). Among non-clonal cases, the most common specific diagnoses were aplastic anemia (5%), megaloblastic anemia (2%), and HIV-related changes (2%); hypocellularity was more common than hypercellularity. Clonal diagnoses were associated with lower hemoglobin levels, absolute neutrophil count, and platelet counts than non-clonal cases. Clinical presenting symptoms included fatigue, fever, bleeding, and dyspnea, but did not differ between clonal and non-clonal cases. Peripheral smear findings of anisocytosis, polychromasia, abnormal lymphocytes, nucleated red blood cells, immature granulocytes, and blasts were seen more frequently in clonal cases than non-clonal, and numbers of reported RBC abnormalities were greater in clonal cases (3.4 vs. 2.0).
Conclusions: Nearly 2/3 of cases of new onset pancytopenia in adults in our North American practice setting have a clonal etiology. Myeloid processes outnumber lymphoid neoplasms (nearly 2.5:1). Compared to non-clonal cases, clonality is associated with more severe cytopenias, greater RBC abnormalities, and the presence of circulating blasts, NRBCs, and immature granulocytes.
Monday, February 28, 2011 1:00 PM
Poster Session II # 164, Monday Afternoon