Pancytopenia¶
Thomas Gracie
Background¶
- Framework for differential:
- Impaired production (aplastic anemia, marrow infiltration, marrow suppression, vitamin/nutritional deficiencies, sepsis, cirrhosis)
- Peripheral destruction (autoimmune hemolytic, hypersplenism)
- Combined process (PNH, SLE, leukemia, HLH, infections)
Evaluation¶
- Medications: NSAIDs, AEDs, steroids, chemotherapy, antivirals, immunosuppression
- PMHx: autoimmune disease (SLE, RA), radiation, gastric surgery, malabsorption, liver disease, hematologic malignancy
- Social Hx: EtOH use, malnutrition, occupational exposures, exposures to TB or leishmaniasis
- Exam: lymphadenopathy, hepatosplenomegaly, neuropathy, petechiae, stigmata of liver disease, cachexia
- Diagnostic studies: CBC w/ diff, CMP, reticulocyte count, peripheral smear, viral studies (hepatitis A/B/C, EBV, CMV, HIV, parvovirus B19), vitamin levels (B12, folate, copper, zinc), iron studies, hemolysis labs (LDH, haptoglobin, Coombs), flow cytometry, bone marrow biopsy, cytogenetics and FISH
Management¶
- For pancytopenia that is acute (hospital onset) often observation is the best approach
- When pancytopenia is slow, progressive over time, or acute without any other precipitating factors then would consult hematology for consideration of a bone marrow syndromes
Last update:
2022-06-24 23:35:57