Clone of ASSESSMENT OF MAGNITUDE AND ETIOLOGY OF PANCYTOPENIA AMONG CHILDREN AT TIKUR ANBESSA SPECIALIZED HOSPITAL, ETHIOPIA

9/7/22, 9:44 AM Clone of ASSESSMENT OF MAGNITUDE AND ETIOLOGY OF PANCYTOPENIA AMONG CHILDREN AT TIKUR ANBESSA SPE…
Clone of ASSESSMENT OF MAGNITUDE AND ETIOLOGY OF

PANCYTOPENIA AMONG CHILDREN AT TIKUR ANBESSA
SPECIALIZED HOSPITAL, ETHIOPIA
Assessment of magnitude and etiology of pancytopenia in children at Tikur Anbessa specialized hospital, 2022
Data collection instrument (Questionnaire)
Socio- demographic factors

PART I. HISTORY: A. Socio-demographic factors
1. Code: __.
2. Total hospital stay or follow-up duration in month
3 Age in month
4. Sex:
A. Male
B. Female
5. Living area:
A. Urban
B. Rural
C. Semi urban
https://kobo.humanitarianresponse.info/#/forms/aNC7dT4wubGTuQr5P8gBZG/landing 1/23
6. Region:
A) Oromia
B) Amhara
C) SNNPR
D) Addis Ababa
E) Somali
F) Others (Tigray, Benishangul gumuz, Harari,….etc)
Presenting symptoms
B )Presenting symptoms
7. Symptoms
Fever
Weight loss
Fatigue
Epistaxis
Skin rash
Palpitation
Body swelling
Loss of appetite
Dizziness
Cough
Vomiting
Diarrhea
Jaundice
Other (night sweat ...)
Any history of drug use

C. Past and family history
8. Any history of drug use, toxins and radiations exposure? (If yes, please tick () in the table below)
Chloramphenicol
Yes
No
Unknown
If yes for how long?
< 1 month
1 month to 1 Yr
> 1 Yr
Zidovudine
Yes
No
Unknown
< 1 month
1 month to 1 Yr
> 1 Yr
Valproic acid
Yes
No
Unknown
< 1 month
1 month to 1 Yr
> 1 Yr
Sulfa drugs
Yes
No
Unknown
< 1 month
1 month to 1 Yr
> 1 Yr
Toxins
Yes
No
Unknown
< 1 month
1 month to 1 Yr
> 1 Yr
Other (anti-seizure...)
Yes
No
Unknown
< 1 month
1 month to 1 Yr
> 1 Yr
Family history
9. Family history of similar illness?
A Yes
B. No
C. Not sure
10. Family history of any identified congenital disease?
A. Yes
B. No
C. Not sure
Physical examination
PART II. PHYSICAL EXAMINATION AT PRESENTATION
11. General appearance:
A. Well looking
B. Acute sick looking
C. Chronically sick looking
D. Dysmorphic features
E. other
If other specify
Vs
12. Vital sign
Temperature
Normal
febrile
Hypothermic
Pulse rate
Normal for age
Tachycardic
Bradycardic
Unknown
Respiratory rate
Normal for age
Tachypenic
Bradypnea
Unknown
Blood pressure
Low
High
Unknown
Normal
Oxygen saturation
Normal
Desaturated (<90%)
Unknown
antropometry
13 Anthropometry
Weight for age
Normal
< -2 SD
> +2 SD
Height/ length for age
Normal
< -2 SD
> +2 SD
What is weight for height/length? (For age group up to 5 year)
a. Normal
b. MAM
c. SAM
What is MUAC for age? (For age above 6 month and height/ length >65cm)
a. Normal
b. MAM
c. SAM
What is BMI for age? (For age group above 5 year)
a. Normal
b. MAM
c. SAM
Is there bilateral leg edema?
Yes
No
Is there failure to gain wt or recent wt loss? (For age group below 6 month only)
Yes
No
system review
14 system Findings
HEENT
Pallor
Jaundice
Other
If other specify
Lymphoglandural
LAP
Other
if other specify
Respiratory
IC/SC retraction
Crackles
Rhonchi
Decreased air entry
Absent air entry
Other
if other specify
Cardiovascular
1. S1 S2 well heard
2. Murmur
3. Gallop
4.Other
if other specify
Abdomen
1.Hepatomegaly
2.Splenomegaly
3. Other
if other specify
Integumentary
1.Pallor
2. skin rash
3.Jaundice
4. Edema
5 other
if skin rash
Petechial
Ecchymosis
Purpura
Edema
Pitting
Non pitting
if other specify
Musculoskeletal
Skeletal deformity
other
Central nervous
1.Alert
2. CN palsies
3. Hemiparesis/plegia
other
if other specify
if other specify
Initial CBC
PART. III. LABORATORY
15. A. Initial CBC and differential, please write in the table below.
WBC per µl
ANC /µl
HGB g/dl
HCT %
MCV fl
RDW
MCH
MCHC
PLT /µl
Viral tests
B. Viral tests: Please use tick () mark in the table below.
PICT
Positive
Negative
Not done
HBsAG
Positive
Negative
Not done
Anti HCV
Positive
Negative
Not done
CMV serology IgG
Positive
Negative
Not done
EBV serology
Positive
Negative
Not done
CMV serology IgM
Positive
Negative
Not done
Serum values
C. Serum values:
Serum vit B12 level
Normal
Low
High
Not done
Serum folate level
Normal
Low
High
Not done
Reticulocyte count
Normal
High
Not done
ANA
Normal(-ve)
High
Not done
rk 39
NR
Reactive
Not done
ferritin
Normal
Low
High
Not done
Bilirubin T
Normal
High
Not done
RF
-ve
+ve
Not done
LDH
Normal
Low
High
Not done
Chromosomal breakage test for FA
-ve
+ve
Not done
Coombs/ Indirect
-ve
+ve
Not done
Coombs/Direct
-ve
+ve
Not done
Anti-Ds DNA antibody (- or +)
-ve
+ve
Not done
PM
16. Did PM done?
Yes
No
I) what was the RBC morphology?
A. Normocytic normochromic
B. Normocytic hyperchromic
C. Macrocytic normochromic
D. Microcytic hypochromic
E. Anisocytosis
F. Poikilocytosis
G. Others
if other specify
II) was there blasts seen?
Yes
No
III) Was there Hyper-segmented neutrophils?
Yes
No
IV) Was there nucleated RBC?
Yes
No
V) What was the suggested diagnosis?
A. Normal findings
B. Non-diagnostic
C. Abnormal
if abnormal for above question
Megaloblastic anemia
IDA
ALL
AML
MDS
Aplastic Anemia
Hemolytic anemia
ITP/Chronic
othe specify
if other for the above question
BMA
17. Did BMA done?
Yes
No
If yes, what was the result or conclusion
A. Trilineage hematopoiesis
B. Inconclusive or non-diagnostic
C. Abnormal :
IDA
ALL
AML
MDS
Neuroblastoma
Lymphoma
Aplastic Anemia
Leishmaniasis
Gaucher disease
Hemolytic anemia
Erythroid hyperplasia
ITP/Chronic
Others
if other for the above question
BMB
18. Did BMB done?
Yes
No
If yes, what was the result or conclusion?
A. Trilineage hematopoiesis
B. Inconclusive or non-diagnostic
C. Abnormal :
IDA
ALL
AML
MDS
Neuroblastoma
Lymphoma
Aplastic Anemia
Leishmaniasis
Gaucher disease
Hemolytic anemia
Erythroid hyperplasia
ITP/Chronic
Others
if other specify
Last CBC
19. Last CBC and differential on follow up
WBC µl
ANC µl
HGB g/dl
HCT %
MCV fl
RDW
MCH
MCHC
PLT µl
MANAGEMENT
PART. IV. DIAGNOSIS, MANAGEMENT AND OUTCOME
20. What was the initial reason for presentation?
A) Infectious complications
B) For complications of anemia (HF, symptomatic anemia, etc…)
C) For bleeding (ICH, GI, Nasal bleeding, etc…)
D) For 2 or more of the above reasons (encircle from the choices)
E) Others
if Infectious complications
I) Neutropenic fever
II) Pneumonia
III) Acute gastroenteritis
IV) Sepsis
V) Others (UTI, URTI, cellulitis, AOM, etc...)
if other specify
if other specify
cause of pancytopenia
21. What was the final cause of pancytopenia?
Unknown
Not investigated properly
Known
If known
Nutritional
Malignancy
Aplastic Anemia
Infections
Other/Miscellaneous
if nutritional
IDA
If Megaloblastic anemia
Vitamin B12 deficiency
Folate deficiency
Both deficency
If Malignancy
ALL
AML
MDS
Neuroblastoma
Lymphoma
other
if Aplastic anemia
Congenital( fanconi anemia, BDA, etc...)
Acquired ( Viral, Drugs etc ...)
unknown
if infection
Viral
Bacterial
Schistosomiasis
VL
Malaria
TORCH
Others
if viral
HIV
Hepatitis B virus
Hepatitis C virus
CMV
If bacterial
TB
Bacterial sepsis
others
if Other/miscellaneous
A. Storage disease
B. Hemolytic anemia
C. Hypersplenism
D. SLE
E. Chronic ITP
F. Drug induced
G. Others
if Storage disease
I) Gaucher disease
II) Others
Blood product Transfusion
22. How was the patient managed? Please use tick () mark in the table below.
Blood product Transfusion given?
PRBC
Yes
No
if Yes
<2x
2 to 5x
> 5x
Whole blood
Yes
No
if Yes
<2x
2 to 5x
> 5x
Platelet
Yes
No
if Yes
<2x
2 to 5x
> 5x
FFP
Yes
No
if Yes
<2x
2 to 5x
> 5x
management
23 Other specific management:
A) Was chemotherapy given?
Yes
No
If yes
ALL protocol
AML protocol
Other
B) Did therapeutic vitamin B12 given?
Yes
No
C) Did therapeutic folate given?
Yes
No
D) Both Vit b12 and folate given at the same time?
Yes
No
E) Any specific therapy (like antiviral, antibacterial, immunosuppressant etc...) was given?
Yes
No
If yes, which one of the following?
a. Ganciclovir
b. HAART
c. Anti-TB
d. Cyclosporine
e Other
F) Was steroid given for specific etiology?
Yes
No
G) Did anti-malarial, antileishmanial, antischistosomal agents, etc… given?
Yes
No
H) Therapeutic iron supplementation given?
Yes
No
I) Others (HSCT, Gene therapy, enzymatic therapy, Splenectomy, etc…)
Yes
No
outcome
24. The final outcome of the patient?
A. Successfully completed treatment
B. On follow up
C. Transferred to other health institution
D. Referred abroad
E. Lost follow up
F. Left against medical advice
G. Disappeared
H. Death
if death its immediate cause: (more than one choice is possible)
i. Infectious complications
ii. Life threatening bleeding
iii. Anemia complications (HF, Hypoxia, etc…)
iv. Other comorbidity (cardiac, respiratory, etc…)
if death with infectious complication
A. NF
B. Sepsis
C. Pneumonia
D. Other
if death with life threatening bleeding
A. ICH
B. GI
C. Others

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9/7/22, 9:44 AM Clone of ASSESSMENT OF MAGNITUDE AND ETIOLOGY OF PANCYTOPENIA AMONG CHILDREN AT TIKUR ANBESSA SPE…

Clone of ASSESSMENT OF MAGNITUDE AND ETIOLOGY OF

Socio- demographic factors

2. Total hospital stay or follow-up duration in month

F) Others (Tigray, Benishangul gumuz, Harari,….etc)

Other (night sweat ...)

Any history of drug use

If yes for how long?

If yes for how long?

If yes for how long?

If yes for how long?

If yes for how long?

If yes for how long?

10. Family history of any identified congenital disease?

PART II. PHYSICAL EXAMINATION AT PRESENTATION

11. General appearance:

B. Acute sick looking

C. Chronically sick looking

Normal for age

Normal for age

Weight for age

Height/ length for age

What is weight for height/length? (For age group up to 5 year)

What is BMI for age? (For age group above 5 year)

Is there bilateral leg edema?

Decreased air entry

Absent air entry

CMV serology IgG

CMV serology IgM

Serum vit B12 level

Serum folate level

Chromosomal breakage test for FA

Anti-Ds DNA antibody (- or +)

I) what was the RBC morphology?

II) was there blasts seen?

III) Was there Hyper-segmented neutrophils?

IV) Was there nucleated RBC?

V) What was the suggested diagnosis?

if abnormal for above question

if other for the above question

If yes, what was the result or conclusion

if abnormal for above question

if other for the above question

If yes, what was the result or conclusion?

if abnormal for above question

20. What was the initial reason for presentation?

B) For complications of anemia (HF, symptomatic anemia, etc…)

C) For bleeding (ICH, GI, Nasal bleeding, etc…)

D) For 2 or more of the above reasons (encircle from the choices)

III) Acute gastroenteritis

V) Others (UTI, URTI, cellulitis, AOM, etc...)

Not investigated properly

Vitamin B12 deficiency

Congenital( fanconi anemia, BDA, etc...)

Acquired ( Viral, Drugs etc ...)

Blood product Transfusion

A) Was chemotherapy given?

B) Did therapeutic vitamin B12 given?

C) Did therapeutic folate given?

D) Both Vit b12 and folate given at the same time?

If yes, which one of the following?

F) Was steroid given for specific etiology?

G) Did anti-malarial, antileishmanial, antischistosomal agents, etc… given?