Pancytopenia resident survival guide: Difference between revisions
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== Quick-take == | |||
Urgent hematology consult. Send out labs as detailed below. Plan for pt to get bone marrow biopsy. | |||
== Visual summary == | |||
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]] | |||
== 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) | |||
<nowiki>#</nowiki>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 | |||
- | |||
- | |||
Revision as of 16:10, 28 May 2016
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
-
-