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| == Quick-take ==
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| *[[Urgent hematology consult]]
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| *[[Send out labs as detailed below]]
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| *[[Bone marrow biopsy]]
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| == Visual summary ==
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| [[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]
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| == Differential ==
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| '''Hypercellular bone marrow (1/Y):'''
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| Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K).
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| Rare: [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]]), [[aleukemic leukemia]], severe [[megaloblastic anemia]]
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| '''Hypocellular bone marrow (1/X):'''
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| [[Aplastic anemia]] (Bone marrow [[stem cell]] failure): idiopathic (most common), viruses ([[Parvo B19]], [[HIV]], [[EBV]], [[HHV6]]), medications ([[chloramphenicol]], [[NSAIDs]], sulfa drugs), other infection (anaplasma)
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| == Workup ==
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| [[Bone marrow biopsy]] required for definitive diagnosis.
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| == Treatment ==
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| Once identified, treat underlying cause.
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| Aplastic anemia: Allogeneic stem cell transplant.
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| == Example A/P ==
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| 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)
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| <nowiki>#</nowiki>Pancytopenia:
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| Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential.
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| The presence of decreased WBC and HCT makes ITP, TTP less likely.
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| Dx:
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| - Hematology consulted, appreciate recs.
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| - Plan for bone marrow biopsy tomorrow AM. NPO at midnight.
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| - Peripheral blood smear
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| - Daily CBC to monitor;
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| - Peripheral flow cytometry
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| - SPEP with immunofixation and free light chains
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| - Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin
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| - Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear
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| - Autoimmune labs: ANA
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| Tx:
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| - Type and screen, transfusion consent to be obtained.
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| - Transfuse for HCT < 21
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