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)

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