Pancytopenia resident survival guide

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

Visual summary

Pancytopenia Visual Guide.PNG


Hypercellular bone marrow (1/Y):

Common: Myelodysplastic Syndrome 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)


Bone marrow biopsy required for definitive diagnosis.


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)


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.


- Hematology consulted, appreciate recs.

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

- Peripheral blood smear

- Daily CBC to monitor;

- Peripheral flow cytometry

- SPEP with immunofixation and free light chains

- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin

- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear

- Autoimmune labs: ANA


- Type and screen, transfusion consent to be obtained.

- Transfuse for HCT < 21