Morphology showed normochromic, anisocytosis, Rouleaux formation, circulating blast cells with Auer rods, bicytopenia
with leukocytosis, neutrophils: 0.
Further investigation revealed bicytopenia
Evaluation showed bicytopenia
(low haemoglobin of 6.
Patients with suggestive clinical features and bicytopenia
, negative reactivity for dengue specific IgM antibody were labeled as probable DF.
Marked megaloblastic changes especially in the myeloid series, plasma cell, marked increase in the number of hystiocytes and a high number of hemofagocytes were observed on bone marrow aspiration biopsy which was performed on the second day of hospitalization because of bicytopenia
This type of spleen removes blood cells (RBCs, WBCs and platelets) at a much faster rate from circulation than their release in circulation and also pooling of blood cells occur in spleen result in bicytopenia
and pancytopenia in the peripheral blood smear17.
Anemia and bicytopenia
was more commonly seen in HAART group.
Given that initially the patient presents with bicytopenia
, unlike the other two cases, complementary studies were performed like superior digestive endoscopy, colonoscopy, computed tomography of the abdomen, thorax, and brain; without finding any abnormality.
From a biological point of view there are found the following: cholestasis, hepatoprive syndrome, prolongation of the prothrombin time (the patient being currently at home under oral anticoagulant treatment), azote retention syndrome, discreet muscular lysis syndrome, hyperglycaemia, bicytopenia
(normocytic hypochromic anaemia + thrombocytopenia) (Table 1).
Table 1: Various causes of thrombocytopenia, bicytopenia
, and pancytopenia in the study group Causes Only Bicytopenia
thrombocytopenia (thrombocytopenia + leukopenia anemia) Dengue 23 86 Malaria 37 49 Chronic liver disease 16 41 Hypersplenism 20 23 Septicemia 9 16 Gestational thrombocytopenia, DIC 6 16 Immune thrombocytopenic purpura 13 0 Megaloblastic anemia 0 4 PLHA 0 6 Drug-induced thrombocytopenia 4 1 Leukemia 0 3 Aplastic anemia 0 0 Total 128 (31%) 245 (59.
51%) was the most common presentation followed by bicytopenia
LCA patients can present with symptoms and signs of hypersplenism and bicytopenia
(anemia and thrombocytopenia).