Pancytopenia resident survival guide

Quick-take

Urgent hematology consult. Send out labs as detailed below. Plan for pt to get bone marrow biopsy.

Visual summary

Differential

Hypercellular bone marrow (1/Y):

Common: MDS (3-4/100K).

Rare: 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:

- Daily CBC to monitor;

- Hematology consulted and following.

- Retics, Folate/B12,

- Aplastic anemia labs:

- Peripheral blood smear

- Plan for bone marrow biopsy tomorrow AM. NPO at midnight.

Tx:

- Transfuse for HCT < 21

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