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Abstract
Introduction : La pancytopénie est un syndrome hématologique défini par une baisse associée des lignées érythrocytaires, granulocytaires et plaquettaires. Elle peut être la conséquence de diverses étiologies exprimant une atteinte primitive ou secondaire de la moelle osseuse. Dans les pays pauvres, les carences vitaminiques et les infections en sont les principales étiologies. Ce travail avait pour objectif d’en déterminer les principales étiologies chez l’adulte dans le service d’hématologie du CHU de Brazzaville.
Matériels et méthodes : Nous avons réalisé une étude transversale rétrospective sur une période de 6 ans (Janvier 2010 – Décembre 2015), sur la base des dossiers des patients vus pour une pancytopénie. La pancytopénie était définie par l’association des critères biologiques suivants : un taux hémoglobine (Hb) < 11 g/dL, un taux de globules blancs (GB) < 4 Giga/l avec un taux de polynucléaires neutrophiles (PNN) < 1,5 Giga/l et un taux de plaquettes (PLT) < 1450 Giga/l.
Résultats : 65 dossiers ont été inclus. La moyenne d’âge des patients était de 42,92 ans. Le sex ratio homme/femme était de 0,85. Le taux moyen d’Hb était de 4,61 g/dL, le taux moyen de GB était de 1,50 Giga/L, le taux moyen des PNN était de 0,350 Giga/l, et celui des PLT était de 53 Giga/l. Les principales étiologies étaient représentées par les hémopathies malignes (38,75%) avec en tête la leucémie aigue, suivies par l’aplasie médullaire (27,00%). Les infections représentaient 14,25% des étiologies et les carences en vitamine (B12) 3%.
Conclusion : Devant une pancytopénie, la fréquence élevée des aplasies médullaires et des leucémies aigues impose la réalisation en première intention d’un myélogramme.
ABSTRACT
Introduction: Pancytopenia is a common hematologic disorder defined by a low count of red cell lines, granulocytes and platelets. It can be the result of various etiologies, expressing a primary or secondary bone marrow involvement. In subafrican countries, vitamin deficiencies and infections are the main causes. The aim of our work was to describe the main causes in adult patients from the hematology department of the University Hospital of Brazzaville.
Materials and Methods: This was a retrospective cross-sectional study of a 6-year period (January 2010 - December 2015), based on the records of patients seen for pancytopenia. Pancytopenia was defined by the combination of the following biological criteria: hemoglobin <11 g /dL, white blood cell count <4 Giga/L with neutrophil count <1, 5 Giga/L and count <1450 Giga/L.
Results: 65 patients were recruited. The average age was 42.92 years. The sex ratio male/female was 0.85. The average values were hemoglobin 4.61 g/dL, white blood cell count 1.50 Giga/L with 0.350 Giga/L for neutrophil cell, platelet 53 Giga/L. The principal etiologies were hematological malignancies (38.75%) mainly acute leukemia, aplastic anemia (27.00%), infections (14.25%), and vitamin B12 deficiencies (3%).
Conclusion: in front of pancytopenia, the high frequency of medullary aplasia and acute leukemia requires immediate myelogram at Brazzaville.
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References
- Shimamura A, Alter BP. Inherited aplastic anemia syndrome. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Gladet B, Arber DA, et al.editors , editors. Wintrobe's clinical hematology. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1173–11261.
- Diana J, Kelm Katherine M, Torres M, M. Rizwan Sohail. 46-Year-Old Man With Fevers, Chills and Pancytopenia Mayo Clin Proc. 2012; 87(8): 799– 802.
- Rangaswamy M, Prabhu Nandini NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc. 2012;110(8):560- 2.
- Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol. 2013;139(1):9- 29.
- Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. JNMA J Nepal Med Assoc. 2008;47(169):12- 7.
- Doshi D, Shah AN, Somani S, Jain A, Jivarajani H, Kothari P. Study of clinical and aetiological profile of 100 patients of pancytopenia at a tertiary care centre in India. Hematology. 2012;17(2):100- 5.
- Lavigne C, Lavigne E, Massenet D, Binet C, Brémond JL, Prigent D. Place des etiologies carentielles dans les pancytopénies à Djibouti: à propos de 81 patients consécutifs. Med Trop. 2005;65: 59- 63.
- 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(4):159- 67.
- Devitt KA, Lunde JH, Lewis MR. New onset pancytopenia in adults: a review of underlying pathologies and their associated clinical and laboratory findings. Leuk Lymphoma. 2014 ;55(5):1099- 105.
- Savage DG, Allen RH, Gangaidzo IT, Levy LM, Gwanzura C, Moyo A et al. Pancytopenia in Zimbabwe. Am J Med Sci. 1999;317(1):22- 32.
- Marchand T, Loschi M. Aplasies médullaires. Hématologie. 2014;20:329-341.
- Gayathri BN, Kadam Satyanarayan R. Pancytopenia: A Clinico Hematological Study. J Lab Physicians. 2011;3(1):15– 20.
- Das Makheja K, Kumar Maheshwari B, Suneel Kumar BA, Kumari S, Vikash. The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci. 2013; 29(5): 1108– 1111.
- Issagridil S, Kaufman DW, Anderson T, et al. The epidemiology of aplastic anemia in Thailand. Blood. 2006;107:1229- 307.
- Nafil H, Tazi I, Sifsalam M, Bouchtia M, Mahmal L. Etiological profile of pancytopenia in adults in Marrakesh, Morocco. East Mediterr Health J. 2012;18(5):532- 6.
- Tareen SM, Bajwa MA, Tariq MM, Babar S, Tareen AM. Pancytopenia in two national ethnic groups of Baluchistan. J Ayub Med Coll Abbottabad. 2011;23(2):82- 6.
- Serraj K, Mecili M, Housni I, Andrès E. Cytopénies et virus d’immunodéficience humaine. mt 2011;17 (3):183- 95.
- Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital. BMC Hematol. 2013;13:10.
- Premkumar M, Gupta N, Singh T, Velpandian T. Cobalamin and Folic Acid Status in Relation to the Etiopathogenesis of Pancytopenia in Adults at a Tertiary Care Centre in North India Anemia. 2012; 2012: 707402.
- Zittoun J. Anémies macrocytaires carentielles. Encycl Méd Chir (Editions Scientifiques et Médicales Elsevier SAS, Paris, tous droits réservés), Hématologie, 13-001-A-10, 2002, 11 p.
References
Shimamura A, Alter BP. Inherited aplastic anemia syndrome. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Gladet B, Arber DA, et al.editors , editors. Wintrobe's clinical hematology. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1173–11261.
Diana J, Kelm Katherine M, Torres M, M. Rizwan Sohail. 46-Year-Old Man With Fevers, Chills and Pancytopenia Mayo Clin Proc. 2012; 87(8): 799– 802.
Rangaswamy M, Prabhu Nandini NM, Manjunath GV. Bone marrow examination in pancytopenia. J Indian Med Assoc. 2012;110(8):560- 2.
Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol. 2013;139(1):9- 29.
Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examination in cases of pancytopenia. JNMA J Nepal Med Assoc. 2008;47(169):12- 7.
Doshi D, Shah AN, Somani S, Jain A, Jivarajani H, Kothari P. Study of clinical and aetiological profile of 100 patients of pancytopenia at a tertiary care centre in India. Hematology. 2012;17(2):100- 5.
Lavigne C, Lavigne E, Massenet D, Binet C, Brémond JL, Prigent D. Place des etiologies carentielles dans les pancytopénies à Djibouti: à propos de 81 patients consécutifs. Med Trop. 2005;65: 59- 63.
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(4):159- 67.
Devitt KA, Lunde JH, Lewis MR. New onset pancytopenia in adults: a review of underlying pathologies and their associated clinical and laboratory findings. Leuk Lymphoma. 2014 ;55(5):1099- 105.
Savage DG, Allen RH, Gangaidzo IT, Levy LM, Gwanzura C, Moyo A et al. Pancytopenia in Zimbabwe. Am J Med Sci. 1999;317(1):22- 32.
Marchand T, Loschi M. Aplasies médullaires. Hématologie. 2014;20:329-341.
Gayathri BN, Kadam Satyanarayan R. Pancytopenia: A Clinico Hematological Study. J Lab Physicians. 2011;3(1):15– 20.
Das Makheja K, Kumar Maheshwari B, Suneel Kumar BA, Kumari S, Vikash. The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci. 2013; 29(5): 1108– 1111.
Issagridil S, Kaufman DW, Anderson T, et al. The epidemiology of aplastic anemia in Thailand. Blood. 2006;107:1229- 307.
Nafil H, Tazi I, Sifsalam M, Bouchtia M, Mahmal L. Etiological profile of pancytopenia in adults in Marrakesh, Morocco. East Mediterr Health J. 2012;18(5):532- 6.
Tareen SM, Bajwa MA, Tariq MM, Babar S, Tareen AM. Pancytopenia in two national ethnic groups of Baluchistan. J Ayub Med Coll Abbottabad. 2011;23(2):82- 6.
Serraj K, Mecili M, Housni I, Andrès E. Cytopénies et virus d’immunodéficience humaine. mt 2011;17 (3):183- 95.
Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital. BMC Hematol. 2013;13:10.
Premkumar M, Gupta N, Singh T, Velpandian T. Cobalamin and Folic Acid Status in Relation to the Etiopathogenesis of Pancytopenia in Adults at a Tertiary Care Centre in North India Anemia. 2012; 2012: 707402.
Zittoun J. Anémies macrocytaires carentielles. Encycl Méd Chir (Editions Scientifiques et Médicales Elsevier SAS, Paris, tous droits réservés), Hématologie, 13-001-A-10, 2002, 11 p.