RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. /NAME OF THE CANDIDATE
AND ADDRESS(IN BLOCK LETTERS) / Dr. B. PURUSHOTHAMA
S/o K. BHEEMAIAH
‘ANUDEEP’ 3RD CROSS, 4TH MAIN
JAYANAGAR WEST
TUMKUR – 572102.
2. /
NAME OF THE INSTITUTION
/ J.J.M. MEDICAL COLLEGE,DAVANGERE – 577 004.
3. / COURSE OF STUDY AND SUBJECT / POSTGRADUATE DEGREE
M.D. GENERAL MEDICINE
4. / DATE OF ADMISSION TO COURSE / 27th May 2010
5. /
TITLE OF THE TOPIC
/ “AETIOLOGY OF PANCYTOPENIA WITH SPECIAL REFERENCE TO BONE MARROW PICTURE”6. / BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the Study:
Cytopenia is a disorder in which production of one or more blood cell types ceases or is greatly reduced.1
Pancytopenia is a disorder in which all three major formed elements of blood (red cells, white blood cells, and platelets) are reduced than normal.2
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 marrow.
The presenting symptoms usually attributable to anemia, leucopenia or thrombocytopenia.3
Pancytopenia is a striking feature of many serious and life threatening illness, ranging from simple drug induced bone marrow hypoplasia megaloblastic marrow to fatal bone marrow aplasias and leukaemias.4
And it is the medical emergency as bleeding and infections due to cytopenias.
Bone marrow evaluation is an invaluable diagnostic procedure in practice of medicine which may confirm the diagnosis of suspected cytopenia from the clinical features and peripheral blood examination or occasionally give a previously unsuspected diagnosis.5
So my study is stressed upon the aetiological causes of the pancytopenia, with special reference to the bone marrow examination to detect the early stage and prevent further complications.
6.2 Review of Literature :
Pancytopenia is the disorder in which three major formed elements of blood with decreased, than normal.
The study of the bone marrow picture is traditionally dated 1888 when Paul Ehrlich described in Goung Woman died after an explosive short illness marked by severe anemia, bleeding and high fever. As a pathologist Ehrlich was stuck by the absence of nucleated RBC’s and the fatty quality of the femoral marrow, opposite findings from the morphology a mechanism of failed blood cell sequestration.6
Surgical trephine biopsy is an older procedure than needle aspiration of the marrow. Piannese in 1903 was first to obtain marrow from the epiphysis of femur.
Pancytopenia is one of the well known haematological manifestations of hypersplenism. Chafford (1907) introduced the term hypersplenism to refer this concept. In 1908 Ghedini trephined the upper third of tibia. Tissue from patients with early cases of aplastic anaemia, could only be examination at autopsy reflected in the medical literature of the early 20th century.
As a result of study of 39 cases Wintose suggested in 1959 that the term aplastic anemia be reserved for use in cases in which pancytopenia exists.
Production of all the elements of the blood formed in the marrow is decreased, severe hypoplasia or aplasia of the marrow is present and no primary disease infiltrating replacing or suppressing active haemopoetic tissue is evident.
Aetiological causes of pancytopenia are on follows7
I primary
II secondary
Primary causes are classified as idiopathic, congenital / familial.
Secondary causes are
Drugs, viral infections, mycobacterial infection, autoimmune disorders chemicals (benzene, arsenic) cytotoxics, malignant infiltration, paroxysmal nocturnal haemoglobinuria.
Diagnosis of pancytopenia is by bone marrow examination of two specimens.8
I. It is the cytology preparation of bone marrow cells obtained by aspiration of the marrow.
II. The second one is needle biopsy of the bone and associated marrow which allows optimal evaluation of bone marrow cellularity, fibrosis, infection and infiltrative diseases.
The specimen can be taken up from sternum or anterior superior iliac spine and stained with
1) Cytochemical stains
2) Immunocytochemical stains
6.3 Objectives of the Study:
1. To study the aetiology (causes) of the pancytopenia
2. Studied with special reference to the bone marrow examination
7. / MATERIALS AND METHODS
7.1 Source of Data :
Minimum of 60 patients both male and female with signs of pancytopenia over a period of 2 years, admitted in Bapuji Hospital and Chigateri General Hospital Davangere attached to JJM Medical College with be included under study.
7.2 Method of Collection of Data (including sampling procedure if any):
Minimum of 60 patients with features of pancytopenia admitted in the two hospitals will be studied over a period of 2 years.
Inclusion criteria :
1) Both male and female patients aged more than 13 years presenting features of pancytopenia, that is
· Hb less than 9g/dL
· TLC less than 4000/cm
· Platelet count less than 100000/cm
Exclusion Criteria:
1) Patients less than 13 years both male and female.
2) Patients on myelotoxic chemotherapy.
Study design :
It is a longitudinal study in patients of pancytopenia its aetiology ,with special reference to bone marrow picture .
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
Yes.
- CBC, bone marrow examination and other relevant investigations
- In bone marrow cytology preparation of bone marrow cells obtained by aspiration of the marrow.
- The needle biopsy of the bone and associated marrow, which allows optimal evaluation of the bone marrow cellularity, fibrosis, infection and infiltrative disease.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes.
8. / LIST OF REFERENCES
1. Cytopenias-Anaemia, leucopenia, neutropenia, thrombocytopenia. www. oncologychannel. com/cytopenia/-46K-6/24/2007.
2. Ishtiaq O, Baqai HZ, Anwer F, Hussai N. Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach. www.ayubmed.edu.pk/JAMC/PAST/16-1/osama.htm-206K-6/24/2007.
3. Guinan EC, Shimamura A. Acquired and inherited aplastic anemia syndromes. In : Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B edts., Wintrobe’s clinical hematology, 11th edn. Philadelphia : Lippincott Williams and Wilkins 2004:p.1397-1419.
4. Kumar R, Kalra SP, Kumar H, Anand AC, Madan M. Pancytopenia-A six year study. JAPI 2001; 49 :1079-81.
5. Nanda A, Basu S, Marwaha N. Bone marrow trephine biopsy as an adjunct to bone marrow aspiration. JAPI 2002; 50 :893-895.
6. Williams DM. Pancytopenia, aplastic anemia and pure red cell aplasia. In : Richardlee G, Forester J, edts., Wintrobes clinical haematology, 10th edn., Vol. 1. London Williams and Wilkins 1999:p.28.
7. Kar M, Ghosh A. Pancytopenia, Post graduate clinic. JIACM 2002;3(1):29-34.
8. Perkins SL. Examination of blood and bone marrow. In: G.R. Richardlee, Johnforester, editors, wintrobes clinical haematology, 10th ed., Williams and Wilkins, London, 1999;1:p.3-27.
9. / Signature of Candidate
10. / Remarks of the Guide
11. / Name and Designation of
(in block letters)
11.1 Guide
11.2 Signature
11.3 Co-Guide (if any)
11.4 Signature
11.5 Head of Department
11.6 Signature / Dr. E.M. SURENDRA M.D
PROFFESOR,
DEPT OF GENERAL MEDICINE,
J.J.M. MEDICAL COLLEGE,
DAVANAGERE – 577 004.
Dr. RAJASEKHARAPPA M.D
PROFESSOR AND HEAD,
DEPT OF GENERAL MEDICINE,
J.J.M. MEDICAL COLLEGE,
DAVANGERE – 577 004.
12. / 12.1 Remarks of the
Chairman and Principal
12.2 Signature