From,Date: 8-11-2011

DR.KAVITA S.HOSAMANI,Bellary:

Post Graduate Student in M.D,

Department of Pathology,

VIMS, Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected Sir,

Subject: Acceptance of registration and forwarding of synopsis.

In reference with the above cited subject, I the undersigned, studying Post Graduate course in M.D Pathology have been allotted the dissertation topic “PANCYTOPENIA A CLINICO–HEMATOLOGICAL STUDY.”Under the guidance of

Dr.C.BHARATH ,Professor and Head, Department of Pathology, VIMS, Bellary.

I request you to kindly forward the synopsis in the prescribed form to the University for approval.

Thanking you,

Yours faithfully

(Dr .Kavita S.Hosamani)

Post Graduate Student in M.D,

Signature of the Guide Department of Pathology,

VIMS,Bellary.

Dr.C.Bharath,

Professor and Head,

Department of Pathology,

VIMS,Bellary.

From, Date: 8-11-2011

The Professor and Head, Bellary.

Department of Pathology,

VIMS, Bellary.

To,

The Registrar,

RajivGandhiUniversity of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Respected Sir,

Sub: Submission of synopsis for registration and forwarding.

As per the regulations of the University for registration of dissertation topic, the following Post Graduate student in M.D. Pathology has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of the department of Pathology.

NAME / TOPIC / GUIDE
DR. KAVITA S. HOSAMANI,
Post Graduate Student in M.D,
Dept. of Pathology,
VIMS, Bellary. / “PANCYTOPENIA A CLINICO – HEMATOLOGICAL STUDY”. / Dr.C. BHARATH ,
Professor and Head,
Department of Pathology,
VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG students at an early date.

Thanking you,

Yours faithfully,

(Dr. C. Bharath)

Professor and Head,

Signature of the Guide Department of Pathology,

VIMS, Bellary.

Dr. C.Bharath,

Professor and Head,

Department of Pathology,

VIMS, Bellary

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,BANGALORE.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and
address / DR.KAVITA S. HOSAMANI
POST GRADUATE IN M.D.PATHOLOGY,
DEPARTMENT OF PATHOLOGY,
VIMS,BELLARY.
2 / Name of the Institution / VIJAYANAGAR INSTITUTE OF
MEDICAL SCIENCES,BELLARY.
3 / Course of the study and subject / MD IN PATHOLOGY.
4 / Date of admission to the course / 31.05.2011
5 / Title of the topic / PANCYTOPENIA-
A CLINICO-HEMATOLOGICAL STUDY.
6
7
8 / BRIEF RESUME OF INTENDED WORK
6.1. Need for study
Pancytopenia is an important clinico-hematological entity encountered in our day to day clinical practice.There are varying trends in its clinical pattern, hematological change, treatment modalities and outcome.It is a disorder in which all three major formed elements of blood( RBC’s, WBC’s and platelets) are decreased in number.It is not a disease entity but a triad of findings that may result from a number of disease processes - primarily or secondarily involving the bone marrow1. The severity of pancytopenia and underlying pathology determine the management and prognosis of the patients2.
The present study is undertaken to evaluate the etiological causes and to study the peripheral blood findings and bone marrow aspirate/biopsy as and when required.This study would help in planning the diagnostic and therapeutic approach in patients with pancytopenia.
6.2 Review of Literature.
Pancytopenia has either cellular or hypocellular bone marrow morphology.Common causes of pancytopenia with hypocellular marrow are aplastic anemia, drugs, toxins, chemotherapeutic agents, irradiation, autoimmune diseases, infection with viruses including Epstein-Barr virus (EBV), cytomegalovirus (CMV), hepatitis virus, human immunodeficiency virus (HIV), and bacterial infection. Pancytopenia with cellular marrow are seenin PNH, haemophagocytosis, hypersplenism and transient disseminated intravascular coagulation ,kala-azar along with SLE and myelodysplastic syndrome (MDS). Rare causes included falciparum malaria, histoplasma, disseminated tuberculosis, Felty’s syndrome, bone marrow non-Hodgkin’s lymphoma, subleukaemic leukaemia and multiple myeloma.
The frequency of pattern of diseases causing pancytopenia varies in different population groups and this has been attributed to differences in methodology, stringency of diagnostic criteria, geographical area, period of observation, genetic differences, nutritional status, prevalence of infection, and varying exposure to myelotoxic drugs3.
There is limited number of studies in evaluating pancytopenic children4.In a study in France by Imbert et al5, 213 adult pancytopenic patients were reviewed and underlying malignant myeloid disorders were found in 42%, various malignant lymphoid disorders in 18%, and aplastic anemia in 10%.
Jha et al6 from Nepal studied 148 patients. The commonest etiology in their study was hypoplastic bone marrow(29%), followed by megaloblastic anemia( 23.6%), and hematological malignancy(21.6%). In children, hypoplastic bone marrow(38.1%) and in adults, megaloblastic anemia (30.2%) were the commonest etiology.
Studies from India on etiology of pancytopenia are limited and have shown variable causes. In a study done on 990 children by Shano Naseem et al4 at P.G.I. Chandigarh, 571(57.7%) had either pancytopenia(17.7%) orbicytopenia(40%). The most common underlying etiology was aplastic aneamia in 47(33.8%) followed by acute leaukemia in 37(26.65%) panctyopenic children. Megaloblastic anaemia was seen in 19(13.7%) children.
In adults, aplastic anemia was found to be the most common cause in reports by Varma et al7 and Kumar et al8. However, studies by Tilak et al2 and Khunger et al9 found megaloblastic anemia to be the most important cause.
In children, Bhatnagar et al10 who analysed 109 patients found megaloblastic anemia as the single most common cause(28.4%), followed by acute leukemia and infections in 21% patients and aplastic anemia in 20% patients.
Gupta et al11 reviewed 105 children and found aplastic anaemia as the most common cause(43%) followed by acute leukemia(25%) and infections of which Kala azar was the most common cause.
Thus, the commonest causes ofpancytopenia reported by different studies throughout the world havebeen aplastic anemia, megaloblastic anemiaand leukemia.
6.3. OBJECTIVES OF THE STUDY
To evaluate the etiological causes of pancytopenia in patient from age group 2 to 70 years.
To study their clinico-hematological profile.
MATERIALS AND METHODS
7.1. SOURCE OF DATA
Patients admitted in paeditric/medicine departments of VIMS,Bellary form
the subjects for our study.
7.2.a) METHOD OF COLLECTION OF DATA
A detail clinical history and physical examination to be performed in each case.
Complete blood count( Hb, TC, DC, Platelet count) by automated blood
counters,peripheral smear, reticulocyte count, Perl’sstain and bone marrow
aspiration/biopsyto be performed wherever feasible.
INCLUSION CRITERIA
Presence of all three of the following :
Hemoglobin < 9gm/dl
Total leukocyte count (TLC) < 4000/microL
Platelet count < 1,00,000/microL
EXCLUSION CRITERIA
Patients who have already been diagnosed with pancytopenia.
Patients who have recently received blood transfusions.
Patients who do not give consent for bone marrow aspiration and biopsy.
7.2 b)SAMPLE SIZEAND DURATION OF THE STUDY
Sample size :75 cases
Duration of study: fromDecember 2011 to December 2013.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS?
The routine investigations including bone marrow aspiration/biopsy
to be carried out with informed consent of patients.
These investigations form part of routine clinical management of patients.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Yes. Ethical Clearance has been obtained from Institutional Ethical
Committee(IEC) of VIMS, Bellary
LIST OF REFERENCES:
  1. Guinan EC, Shimamura A. Aquired and inherited aplastic anemia syndromes In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, editors. Wintrobe’s Clinical Hematology.11th ed,Philadelphia: Lippincott Williams and Wilkins;2004.p.1397-419.
  2. Tilak V, Jain R. Pancytopenia- A clinico-hematological analysis of 77 cases. Indian J Pathol Microbiol 1999; 42:399-404.
  3. International agranulocytosis and aplastic anemia study. Incidence of aplastic anemia: The relevance of diagnostic criteria. Blood 1987;70:1718-21.
  4. Shano Naseem, Neelam Varma, Reena Das, Jasmina Ahluwalia, Man Updesh Singh Sachdevas,Ram Kumar Marwaha.Pediatric patients with bicytopenia/pancytopenia: Review of etiologies and clinico-hematological profile at a tertiary center. Indian J Pathol Microbiol 2011;54: 75-80.
  5. Imbert M, Scoazec JY, Mary JY, Jouzult H. Rochant H, Sultan C. Adult patients presenting with pancytopenia: A reappraisal of underlying pathology and diagnostic procedures in 213 cases. Hematol Pathol 1989;3: 159-67.
  6. Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. J Nepal Med Assoc 2008;47: 12-7.
  7. Verma N,Dash S. A reappraisal of underlying pathololgy in adult patients presenting with pancytopenia. Trop Georg Med 1992;44:322-7.
  1. Kumar R, Kabra SP, Kumar H, Anand AC, Madan H. Pancytopenia- a six year study. J Assoc Phys India 2001; 49: 1078-81.
  2. Khunger JM, Arunselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia- a clinico-hematological analysis of 200 cases. Indian J Pathol Microbiol 2002; 45: 375- 9.
  3. Bhatnagar SK, Chandra J, Narayan S, Sharma S, Singh V, Dutta AK. Pancytopenia in children: Etiological profile. J Trop Pediatr 2005;51:236-239.
  4. Gupta V, Tripathi S, Tilak V, Bhatia BD. A study of clinico-haematological profilesof pancytopenia in children. Trop Doct 2008; 38: 241-3.

9 / Signature of the candidate
10 / Remarks of the guide
11 / 11.1. Name and designation of the guide / Dr.C.BHARATH,
PROFESSOR AND HEAD,
DEPARTMENTOF PATHOLOGY,
VIMS, BELLARY.
11.2. Signature
11.3. Head of the Department / Dr. C.BHARATH,
PROFESSOR AND HEAD,
DEPARTMENT OF PATHOLOGY,
VIMS, BELLARY.
11.4. Signature
12 / 12.1. Remarks of the Chairman
and Principal
12.2. Signature.