Etiological Spectrum of Bone Marrow and Trephine Biopsy in Patients Presenting with Pancytopenia and Bicytopenia: A Retrospective Analysis (2016-2024)

Abstract

Background: The etiological spectrum varies across different populations due to geographic, socioeconomic, and disease-related factors. However, data describing the underlying causes of cytopenias in the local Pakistani population remain limited, making it difficult to establish region-specific diagnostic priorities.

Objective: To determine the etiological spectrum of pancytopenia and bicytopenia in patients undergoing bone marrow biopsy at a tertiary care hospital.

Methods: This retrospective study was conducted at the Civil Hospital, Karachi, Pakistan. We reviewed the bone marrow biopsy records of patients presenting with bicytopenia and pancytopenia between January 2016 and June 2024. A total of 200 cases were included in this study. Cytopenias were defined as hemoglobin <10 g/dL, a total leukocyte count <4,000/mm³ and a platelet count <150 × 10⁹/L. Data were analyzed using SPSS version 24.0 and summarized using descriptive statistics.

Results: Out of 200 patients, 172 (86%) had bicytopenia and 28 (14%) had pancytopenia, with a male predominance. The mean age was 24.8 years. Males were more frequently affected, and the male-to-female ratio was 1.04. Fever, 131 (65.5%), Pallor, 35 (17.5%), bleeding, 33 (16.5%), and splenomegaly, 31(15.5%) were the most frequent presentations of bicytopenia and pancytopenia. The etiological spectrum showed that aplastic anemia was present in 43 (21.5%) of the cases, followed by acute leukemia in 26 (13.0%) and megaloblastic anemia in 21 (10.5%).

Conclusion: The most common cause of cytopenia was found to be aplastic anemia, followed by acute leukemia and megaloblastic anemia.