Pancytopenia resident survival guide

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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

Increased peripheral destruction

Other causes

For a full list of pancytopenia causes, click here.

Diagnosis

Diagnosis of pancytopenia is outlined in the algorithm below.

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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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Do's

Dont's

References