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Thomas Gracie


  • 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)


  • 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


  • 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