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Differentiating Pancytopenia from Other Diseases

There are no other mimickers of pancytopenia, as the diagnosis can be unequivocally established by laboratory testing (complete blood count).

Category	Condition	Etiology	Mechanism			Congenital	Acquried	Clinical manifestations									Para−clinical findings									Gold standard	Associated findings
								Demography	History	Symptoms			Signs				Para−clinical findings
										Symptoms			Signs				Lab Findings								Imaging
										Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other	CBC			PBS	Bone marrow exam	PT	PTT	UA
			Bone marrow infiltration	Bone marrow failure	Destruction/ sequestration/ redistribution					Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA
Hematologic disorders	Myelodysplastic syndrome^[1]	Bone marrow infiltration Ineffective hematopoiesis	+	+	-	±	+	Elderly	Exposure to Chemotherapy Radiation therapy Tobacco smoke	Petechiae Purpura Diffuse erythematous rash	+	+	Nl	+	+	Shortness of breath Fatigue Pallor	↓	↓	↓	Ovalomacrocytosis Basophilic stippling Howell-Jolly body Dysplastic neutrophils	Impaired myeloid maturation Dyserythropoiesis Dysgranulopoiesis Dysmegakaryocytopoiesis Hypercellular bone marrow Fibrosis	Nl	Nl	Nl	NA	Bone marrow examination + clinical manifestation	Might transformed to acute leukemia
	Malignancies such as:^[2]^[3] Acute leukemia Chronic leukemia Multiple myeloma Metastatic cancer	Bone marrow infiltration Ineffective hematopoiesis Immune mediated	+	+	+	±	±	Any, more in adults	Exposure to chemicals Radiation Pre-existent blood disorders	Petechiae	+	+	Nl	+	-	Weakness	↓	↓	↓	Pancytopenia	Blast cells	↑	↑	Hemoglobinuria	NA	Bone marrow examination	Tumor lysis syndrome Infection CNS involvement DIC
	Myelofibrosis	Bone marrow infiltration	+	+	-	+	+	Average 60 years old		Pallor Major weight loss	+	+	Nl	+	-	Weakness Fatigue Shortness of breath Headache	↓	↓	↓	Pancytopenia	Pancytopenia Hypercellular bone marrow Fibrosis	↑	↑	Hemoglobinuria	NA	Bone marrow examination	Arrhythmia Infection Seizure May progress to malignancy
	Fanconi anemia
	Condition	Etiology	Bone marrow infiltration	Bone marrow failure	Destruction/ sequestration/ redistribution	Congenital	Acquried	Demography	History	Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings
	Aplastic anemia	Immune destruction		+
	Paroxysmal nocturnal hemoglobinuria	Immune destruction		+
	Disseminated intravascular coagulation	Consumption
	Dyskeratosis congenital/telomere biology disorders
	Shwachman-Diamond syndrome					+
Immunology/ Rheumatology	Condition	Etiology	Bone marrow infiltration	Bone marrow failure	Destruction/ sequestration/ redistribution	Congenital	Acquried	Demography	History	Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings
	SLE
	Felty syndrome
	Wiskott Aldrich syndrome					+
	GATA2 deficiency					+
	Hemophagocytic lymphohistiocytosis					+
GI disorders	Portal hypertension/cirrhosis	Splenomegally
GI disorders	Storage diseases (eg, Gaucher)	Splenomegaly Bone marrow infiltration	+		+
Infections	Condition	Etiology	Bone marrow infiltration	Bone marrow failure	Destruction/ sequestration/ redistribution	Congenital	Acquried	Demography	History	Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings
	Sepsis	Bone marrow infiltration
	Viral infection such as HIV, hepatitis, Epstein-Barr virus	Marrow suppression Splenomegaly		+	+
Nutritional	Megaloblastic anemia	Ineffective hematopoiesis		+
	Excessive alcohol	Ineffective hematopoiesis
	Other nutritional deficiency such as copper deficiency, zinc toxicity	Ineffective hematopoiesis
	Malnutrition	Ineffective hematopoiesis
Medications	Medications such as: Cytotoxic drugs Idiosyncratic reactions to medications	Immune destruction		+
Category	Condition	Etiology	Bone marrow infiltration	Bone marrow failure	Destruction/ sequestration/ redistribution	Congenital	Acquried	Demography	History	Appearance	Fever	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings

↑ Natelson, Ethan A.; Pyatt, David (2013). "Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog". Advances in Hematology. 2013: 1–11. doi:10.1155/2013/309637. ISSN 1687-9104.
↑ Oshima Y, Yuji K, Tanimoto T, Hinomura Y, Tojo A (2013). "Association between acute myelogenous leukemia and thrombopoietin receptor agonists in patients with immune thrombocytopenia". Intern. Med. 52 (19): 2193–201. PMID 24088751.
↑ Oshima, Yasuo; Yuji, Koichiro; Tanimoto, Tetsuya; Hinomura, Yasushi; Tojo, Arinobu (2013). "Association between Acute Myelogenous Leukemia and Thrombopoietin Receptor Agonists in Patients with Immune Thrombocytopenia". Internal Medicine. 52 (19): 2193–2201. doi:10.2169/internalmedicine.52.0324. ISSN 0918-2918.

[NatelsonPyatt2013-1] Natelson, Ethan A.; Pyatt, David (2013). "Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog". Advances in Hematology. 2013: 1–11. doi:10.1155/2013/309637. ISSN 1687-9104.

[pmid24088751-2] Oshima Y, Yuji K, Tanimoto T, Hinomura Y, Tojo A (2013). "Association between acute myelogenous leukemia and thrombopoietin receptor agonists in patients with immune thrombocytopenia". Intern. Med. 52 (19): 2193–201. PMID 24088751.

[OshimaYuji2013-3] Oshima, Yasuo; Yuji, Koichiro; Tanimoto, Tetsuya; Hinomura, Yasushi; Tojo, Arinobu (2013). "Association between Acute Myelogenous Leukemia and Thrombopoietin Receptor Agonists in Patients with Immune Thrombocytopenia". Internal Medicine. 52 (19): 2193–2201. doi:10.2169/internalmedicine.52.0324. ISSN 0918-2918.

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Sandbox: sadaf

Differentiating Pancytopenia from Other Diseases

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