Pancytopenia resident survival guide: Difference between revisions
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Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). | Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). | ||
Rare: PNH, aleukemic leukemia, severe megaloblastic anemia | Rare: [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]]), [[aleukemic leukemia]], severe [[megaloblastic anemia]] | ||
'''Hypocellular bone marrow (1/X):''' | '''Hypocellular bone marrow (1/X):''' | ||
Revision as of 12:59, 1 June 2016
Quick-take
Visual summary
Differential
Hypercellular bone marrow (1/Y):
Common: Myelodysplastic Syndrome (MDS) (3-4/100K).
Rare: Paroxysmal nocturnal hemoglobinuria (PNH), aleukemic leukemia, severe megaloblastic anemia
Hypocellular bone marrow (1/X):
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)
Workup
Bone marrow biopsy required for definitive diagnosis.
Treatment
Once identified, treat underlying cause.
Aplastic anemia: Allogeneic stem cell transplant.
Example A/P
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)
#Pancytopenia:
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential.
The presence of decreased WBC and HCT makes ITP, TTP less likely.
Dx:
- Hematology consulted, appreciate recs.
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight.
- Peripheral blood smear
- Daily CBC to monitor;
- Peripheral flow cytometry
- SPEP with immunofixation and free light chains
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear
- Autoimmune labs: ANA
Tx:
- Type and screen, transfusion consent to be obtained.
- Transfuse for HCT < 21