Pancytopenia resident survival guide
Hypercellular bone marrow (1/Y):
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.
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