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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