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Test Findings
 
 

Pancytopaenia

 
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Overview

Pancytopaenia is a reduction in all three haematologic cell lines. This may be due to bone marrow pathology, or less commonly, due to splenic sequestration of cells.
  • Features of Pancytopaenia

  • Anaemia - reduced haemoglobin, haematocrit, red cell count
  • Leukopaenia - reduced white cell count (usually reduced neutrophils)
  • Thrombocytopaenia - reduced platelet count.
  • Causes of Pancytopaenia

  • Aplastic Anaemia

  • Inherited - Fanconi anaemia, dyskeratosis congenita, Schwachman-Diamond syndrome
  • Acquired - drugs, viruses, graft-vs-host disease, idiopathic
  • Bone Marrow Suppression / Destruction

  • Infection - HIV, hepatitis B, hepatitis C, EBV, CMV, HHV6, HHV8, tuberculosis
  • Autoimmune disease - rheumatoid arthritis, SLE
  • Drugs - cytotoxic chemotherapy
  • Alcohol abuse
  • Paroxysmal nocturnal haemoglobinuria
  • Haemophagocytic lymphohistiocytosis (HLH)
  • Ineffective Haematopoiesis

  • Megaloblastic anaemia - B12 deficiency, folate deficiency, drugs
  • Myelodysplastic syndrome
  • Bone Marrow Infiltration

  • Haematologic malignancy - leukaemia, lymphoma, myeloma
  • Metastatic solid organ malignancy
  • Myelofibrosis
  • Sequestration

  • Hypersplenism - congestive cardiac failure, liver cirrhosis, portal vein thrombosis, infection, autoimmune disease, haematologic malignancy, myelofibrosis, storage disorders
  • Clinical Pearls

  • Track the course of the pancytopaenia over time - is it acute or chronic?
  • Take a comprehensive history in a patient with pancytopaenia - particularly infectious symptoms, past medical history, medication history and alcohol intake.
  • Correlate the patient's history with targeted tests including viral serology, haematinics and autoimmune tests where appropriate.
  • Assess the reticulocyte count - reduced reticulocytes suggests bone marrow failure, while increased reticulocytes suggests increased destruction.
  • Assess the blood film for blasts, dysplastic changes, megaloblastic changes and other features suggestive of a cause.
  • A bone marrow biopsy may be required if no cause is found.
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