Our Experience With Bicytopenia in Patients Treated at The Ankara Hospital Pediatric Clinic
Our Experience With Bicytopenia in Patients Treated at The Ankara Hospital Pediatric Clinic
Our Experience With Bicytopenia in Patients Treated at The Ankara Hospital Pediatric Clinic
Abstract
Objective: Bicytopenia is a potentially life-threatening or a temporary situation that can be seen in patients. It
may develop as a result of benign or malign reasons. This study performed a clinical and hematological evalu-
ation of children with bicytopenia and determined the etiologic reasons.
Material and Methods: From 1606 patients, between 6 months and 17 years of age, hospitalized in the Ankara
Research and Treatment Hospital Pediatric Clinic and intensive care unit between February 2012 and February
2013, 28 of them had bicytopenia, and they were considered in this study. The physical examination findings,
total blood count findings, peripheral smear findings, viral infection findings, diagnostic findings, KI aspiration/
biopsy results, and cure time of bicytopenia for each patient were recorded.
Results: We found that 57.1% of the patients were male, and the medium age was 9.2±6.9 (6 months-17
years). The etiologic causes of bicytopenia included 64.2% infection, 7.1% idiopathic thrombocytopenic pur-
pura, 7.1% medicine use, 3.5% megaloblastic anemia, 3.5% chronic illness anemia (celiac disease), and 14.2%
acute leukemia.
Conclusion: We think that in patients with bicytopenia, all viral causes should be investigated, and peripheral
smears should certainly be evaluated; in case of suspicion, bone marrow aspiration/biopsy should be per-
formed, and malignity should be considered. (J Pediatr Inf 2014; 8: 23-7)
Keywords: Bicytopenia, infection, malignity
The decrease in the number of thrombosis (<150000/ Analyses of the data was performed by the SPSS
mm3) or their function getting defected are the most (Statistical Package For the Social Sciences) for Windows
important reasons for rashes, petechia-purpura develop- 15.0. Whether the distribution of continuous and discrete
ment and bleeding tendency. Patients may have anemia- numeric variables was close to normal was analyzed by
driven exhaustion, fatigue, loss of appetite; and neutrope- the Kolmogorov Smirnov test. The variables (age, ESR)
nia-caused fever and infections (9, 10). confirming to normal distribution were shown as
The aim of this study is to examine children with bicy- average±standard deviation; non-normal distribution
topemia clinically and hematologically and identify their (CRP) medium in the form of (1st quarter-3rd quarter);
etiologic reasons. categorical variables, number of cases and “%”.
Twenty-eight patients with bicytopenia out of 1776 1 Bicytopenia was found in 1.57% of the patients who
month to 17 year-old, hospitalized and followed up in the were hospitalized at the pediatric ward and intensive care
intensive care unit of Pediatric Department of Ankara unit and monitored at our hospital between February 2012
Hospital were included in this study between February and February 2013. Sixteen (57.1%) patients were male
2012 to February 2013. Physical examination findings of and 12 (42.9%) were female; the average age of male
the patients on admission, complete blood count, periph- and female patients were 9.2±6.9 year (6 month-17 year
eral smear findings, erythrocyte sedimentation rate (ESR) of age).
and C-reactive protein (CRP), acute phase reactants as Nineteen (67.8%) had fever on admission, 4 (14.2%)
cultures, viral tests (HSV, CMV, EBV, Parvo virus), diagno- weakness, 4 (14.2%) rashes and 1 (3.5%) admitted for
sis of the patients, the therapies they received, BM aspira- short stature (Table 1). Five patients had the history of
tion/biopsy results and recovery duration of bicytopenia drug use prior to admission. On their physical examina-
were all recorded. tion, 4 (14.2%) had petechia, 3 (10.7%) hepatomegaly
Cancer patients, congenital or acquired aplastic ane- and 1 (3.5%) short stature; no lymphadenopathy was
mia, congenital and cyclical neutropenia cases, chronic found in the patients.
idiopathic thrombocytopenic purpura (ITP) patients were As a result of laboratory analyses, 24 (85.7%) patients
excluded from the study. had neutropenia, 7 (30.7%) mild neutropenia, 4 (30.7%)
Complete blood count was assessed by Beckman moderate neutropenia and 2 (15.3%) severe neutropenia.
Coulter LH 780 hemogram device was used by getting 16 (57.1%) patients had anemia and 20 patients (71.4%)
EDTA-blood. Cytopenia was defined as; Hb <11 g/dL, thrombocytopenia. In the evaluation of peripheral smear,
leukocyte count <4000/mm3 and platelet count <150 000/ 3 (10.7%) patients had blast (Table 2). Sedimentation rate
mm3. Bone morrow aspiration and biopsy was performed on average was 12.5±10.7 (2-41) mm/sa and it was high
to the patients if there was a clinical indication. Acute in 7 (25%) patients. C-reactive protein median was 9.5
phase reactants of ESR>20 mm/sa and CRP>0.8 mg/dL (1st quarter: 0.3-3rd quarter: 0.65) and it was high 6
were defined as meaningful. (21.4%) patients.
Results of bicytopenia etiology were (-) Salmonella,
Informed consent was taken from the parents before
Brusella, TORCH, EBV and Hepatitis A, B, C, Mumps IgG.
the study and the study was approved by the ethical com-
Parvo virus was found in 2 (11.1%) patients.
mittee of our hospital at the 454-numbered meeting in
Among the etiologic factors in patients, 18 (64.2%) had
February 2012.
an infection focus. The infections in question were respec-
Table 1. Symptomatic and physical therapy findings of the tively: 10 (55.5%) had upper respiratory infection (URTI),
patients (n=28)
3 (16.6%) pneumonia, 2 (11.1%) acute gastroenteritis, 2
n % (11.1%) Parvo virus and 1 (5.5%) urinary tract infection. It
Fever 19 67.8 was observed that 2 patient had (7.1%) ITP, 2 (7.1%) drug
Exhaustion 4 14.2 use, 1 (3.5%) megaloblastic anemia, 1 (3.5%) chronic
Petechial rashes 4 14.2 disease anemia and neutropenia. In the further examina-
Short stature 1 3.5 tions of this patient, coeliac disease emerged. The 7
patients (25%) with bicytopenia were given BM aspiration/
Hepatomegaly 3 10.7
biopsy and 4 (14.2%) patients were diagnosed with acute
Splenomegaly 1 3.5
leukemia (Table 3).
Yalaki et al.
J Pediatr Inf 2014; 8: 23-7 Bicytopenia in Pediatric Patients 25
Table 2. Results of the complete blood cell count of the patients Table 3. Etiologic reasons in patients with bicytopenia (n=28)
n % n %
Leukocyte count (<4000/mm3) 24 85.7 Infection 18 64.2
ANC Mild (1001-1500) 7 25 URTI 10 35.7
Moderate (501-1000) 4 14.2 Pneumonia 3 10.7
Severe (0-500) 2 7.1 Acute gastroenteritis 2 7.1
Hb (<11 g/dL) 16 57.1 Parvo virus 2 7.1
Thrombosis count (<150 000/mm3) 20 71.4 Urinary Tract Infection 1 3.5
ANC: Absolute neutrophil count ALL 4 14.2
ITP 2 7.1
Twenty-two (78.5%) patients were given antibiotic
Drug use 2 7.1
therapy. Recovery period of bicytopenia was on average
Megaloblastic anemia 1 3.5
6.5±2.1 day (4-11).
Coeliac disease 1 3.5
Discussion ITP: idiopathic thrombocytopenic purpura; URTI; upper respiratory
infection
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