Pancytopenia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[2]

Synonyms and keywords: Approach to pancytopenia, Approach to anemia

Pancytopenia Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Overview

Pancytopenia is described as a decrease in the 3 cell lines which are red blood cells, white blood cells and platelets. Clinically, pancytopenia is defined as hemoglobin< 9gm, white blood cell count< 4,000/cmm and platelets < 100,000/cmm. It can be due to decreased production in the bone marrow or increased destruction of cells in the periphery. Pancytopenia can also be caused due to drugs such as chemotherapy agents. Treatment involves identifying the underlying cause and appropriate therapy.

Causes

Decreased production of cells

• Aplastic anemia
• Myelodysplasia
• Myelofibrosis
• Diamond-Blackfan syndrome
• Fanconi's anemia
• Leukemia

Increased peripheral destruction

• Splenomegaly
• Hypersplenism

Other causes

• Chemotherapy
• Parvovirus B-19 infection
• Autoimmune conditions
• Human immunodeficiency virus infection
• Tuberculosis
• Lymphoma

For a full list of pancytopenia causes, click here.

Diagnosis

Diagnosis of pancytopenia is outlined in the algorithm below.

{{familytree | | | | | | | | C01 | | | | C01=

First line investigations
❑ Peripheral smear
❑ Complete blood count with reticulocyte count
❑

Thorough history must be taken including ❑ Symptoms of autoimmune disease such as * joint pain and swelling *rash * lymphadenopathy etc ❑ History of malignancy ❑ History of recent infections ❑ History of usage of drugs which cause marrow suppression such as * azathioprine and other chemotherapy drugs * corticosteroids * linezolid * chloramphenicol etc ❑ History of chemo or radiotherapy ❑ nutritional status ❑ Family history of anemia or pancytopenia

Manifestations of decrease in each cell line Decrease in RBCs ❑ dyspnea ❑ fatigue ❑ pallor ❑ chest pain Decrease in WBCs ❑ increased susceptibility to infections ❑ fever Decrease in platelets ❑ petechiae ❑ easy bruising ❑ bleeding Other signs to look for are ❑ Signs of liver disease ❑ Splenomegaly ❑ Lymphadenopathy ❑ Signs of eating disorders ❑ Signs of alcoholism ❑ Signs of Vitamin B12 or folate deficiency

Do's

• Screen for infections like hepatitis, HIV, Parvovirus-B19, Epstein Barr virus, etc.
• Periodic, regular blood tests must be done for patients on methotrexate or other marrow suppressing drugs.
• Patients who have pancytopenia must be counselled against the use of drugs such as aspirin and other NSAIDs which may cause bleeding.