Pancytopaenia
April 28th, 2020
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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