Pancytopenia in Zimbabwe

Background: There has been little systematic study of the clinical spectrum of pancytopenia, and the optimal diagnostic approach to pancytopenia remai ns undefined. Methods: The authors studied 134 hospitalized pancytopenic patients in Zimb abwe in both consecutive and nonconsecutive fashion. Results: The most common cause of pancytopenia was megaloblastic anemia, fo llowed by aplastic anemia, acute leukemia, acquired immunodeficiency syndro me (AIDS), and hypersplenism. Severe pancytopenia was usually due to aplast ic anemia. Patients with aplastic anemia and acute leukemia mere usually ch ildren, whereas those with megaloblastic anemia were adults. Moderate to se vere anemia was noted throughout the series, but was most striking in patie nts with megaloblastic anemia, aplastic anemia, and acute leukemia. The mea n corpuscular volume (MCV) was elevated in most patients with megaloblastic hematopoiesis, aplastic anemia, and acute nonlymphocytic leukemia. Normal or low MCV values were noted in almost one third of patients with megalobla stic anemia. Anisocytosis, poikilocytosis, macroovalocytosis, microcytosis, fragmentation, and teardrop erythrocytes were more prominent on the blood films of patients with megaloblastic anemia. Conclusions: Megaloblastic anemia, aplastic anemia, and AIDS are the most c ommon causes of pancytopenia in Zimbabwe. Aplasia is the most frequent caus e of severe pancytopenia. The authors have formulated tentative guidelines for the evaluation of pancytopenic patients in this setting.