Etiological, clinical and haematological characteristics of patients with pancytopenia presenting to the adult emergency department of a university hospital

Introduction Pancytopenia is a haematological disorder characterized by a decrease in all three peripheral blood cell lines and it is a relatively common phenomenon encountered in clinical practice. Pancytopenia is a prominent aspect of several severe and life-threatening diseases, extending from basic drug-induced bone marrow hypoplasia to fatal bone marrow failures and leukemias. The characteristics of patients with pancytopenia assessed in hematology and pathology clinics have been previously evaluated, but pancytopenia patients presenting to the emergency department have not. However, emergency departments frequently serve as the initial point of diagnosis for patients presenting with pancytopenia. The aim of our study was to evaluate the aetiological, clinical and haematological characteristics of patients with pancytopenia admitted to the emergency department of a tertiary care hospital. Material and methods The study included 541 patients who presented to the emergency department with pancytopenia, retrospectively. Age, gender, presence of comorbidities and laboratory data were obtained from patient files. Admission symptoms and findings, etiology of pancytopenia and medication history related to pancytopenia were recorded. Emergency outcomes of the patients were evaluated as ward hospitalization, discharge, ICU hospitalization and exitus. In-hospital mortality rates were evaluated and patients who died within the first 7 days were classified as early mortality. It was planned to compare the descriptive and clinical characteristics of the patients by grouping them according to early mortality and gender. Analyses with a p value below 0.05 were considered significant. Results The mean age of the patients was 63.7 ± 16.0 years (20-96 years). The male/female ratio was 1.2/1. Symptoms related with anemia (weakness, palpitations, pallor, dizziness) were observed in 74.5%, neutropenia (fever) in 36.2% and thrombocytopenia in 19% and of the patients. The most common etiologies of pancytopenia were haematological malignancy (34.9%), drug hypersensitivity (32.0%), infection (14.4%), megaloblastic anemia (8.9%), haematological disease (3.7%), hypersplenism (1.8%) and aplastic anemia (1.1%), and others (11.8%) respectively. The immediate outcome of the patients was ward admission in 71.1%, discharge in 15.1%, and ICU admission in 11.4%. The early hospital mortality rate for the first 7 days was 4.5%. There were no differences between patients who died within the first 7 days and those who survived in terms of demographic characteristics, symptoms and signs, laboratory results, and emergency outcome. The frequency of infection-related pancytopenia was higher in patients who died (p<0.001). The mean age of male patients was higher than that of female patients (p<0.001). The frequency of haematological malignancies was significantly higher in males than females (p=0.002). Among haematological malignancies, the frequency of lymphoma (p=0.011) was higher in males, whereas no difference was observed in the frequency of acute leukemia, myelodysplastic syndrome and multiple myeloma. The frequency of non-malign haematological diseases (idiopathic thrombosis purpura, thrombotic thrombosis purpura) was higher in females (p=0.030). However, there were no differences in symptoms, findings or emergency department outcomes between males and females. Conclusion Patients with pancytopenia presenting to the emergency department show different demographic, clinical and etiological characteristics. In our study, hematological malignancy, drug hypersensitivity, and infection, a significant proportion of which were diagnosed for the first time in the emergency department, are among the top etiological causes. A significant proportion of patients are admitted to other services for further examination and treatment. Knowing these features associated with pancytopenia may help improve the prognosis of patients by allowing early diagnosis and treatment. Keywords: Pancytopenia, Emergency department, Etiological, Clinical, Haemotlogical features