Management of Childhood Pancytopenia

Pancytopenia usually presents with symptoms of bone marrow failure such as pallor, dysnea, brusing and increased tendency to infections. The incidence of various disorders causing pancytopenia varies according to Geographical distribution and genetic mutations. It can result from : * Failure of production of hematopoietic progenitors in bone marrow as in aplastic aneamia. * Bone marrow infiltration by malignant cells as in acute leukemia. * Antibodies mediated bone marrow suppression as in systemic lupus. * Ineffective hematopoiesis and dysplasia as in nutrition deficiency. * Peripheral sequestration of blood cells in over active reticuloendothelial system as in hypersplenism. Pancytopenia is not a disease entity but a triad of findings that may result from primary or secondary bone marrow involvement. Bone marrow aspiration and biopsy evaluation along with clinical correlation are important to evaluate the causes of pancytopenia and plan further investigations and treatment. Pancytopenia can result from damage to bone marrow evidanced by low reticulocyte count, or increased destruction of the peripheral blood with increased reticulocyte count. Bone marrow examination is a simple and safe invasive procedure for evaluating the causes of pancytopenia. The hypoplastic marrow which occurs in 2% of pediatrics acute lymphoblastic leukemia may be misdiagnosed as aplastic aneamia. Studies done have shown leukemia to be the second most common cause of pancytopenia in pediatrics, marginally behind aplastic aneamia.