Pancytopenia

• Pancytopenia:

  • Decrease in all peripheral blood cell lines - red blood cells, white blood cells and platelets
  • Important to exclude underlying haematological malignancy
• Mechanisms:

  • Bone marrow suppression - haematopoiesis is reduced
  • Bone marrow infiltration - impaired haematopoiesis
  • Blood cell destruction - increased turnover of blood cells in the peripheral circulation due to destruction or sequestration in organs e.g. spleen
• Causes:

  • Haematological malignancies - leukaemia, lymphoma, multiple myeloma, myelodysplastic syndrome
  • Metastatic disease - lung, breast and prostate
  • Infections - TB, fungal, HIV
  • Nutritional deficiencies - B12 and folate
  • Medications and toxins - alcohol, azathioprine, methotrexate, carbamazepine
  • Autoimmune - aplastic anaemia, SLE
  • Peripheral destruction - DIC
  • peripheral sequestration - portal hypertension
• Characteristic features include fatigue (anaemia), recurrent infections (leucopenia), and bruising (low platelets)
• The cardinal features of pancytopaenia include:

  • Lethargy
  • Weakness
  • Pallor
  • Bruising
  • Bleeding
  • Recurrent infections.
• Examination:

  • Look for signs of underlying haematological malignancy
  • Lymphadenopathy
  • Organomegaly - splenomegaly, hepatomegaly
  • Scleral findings - pale, jaundiced
  • Oral - ulcers, thrush (e.g. as immunocompromised)
  • Features of cardiac failure due to symptomatic anaemia
  • Skin findings - pale, jaundiced, bruising, petechiae, purpura
  • Other - joint pain or swelling, sarcopenia, active bleeding
• Peripheral blood film:

  • Circulating blasts (immature white blood cells) - suggestive of leukaemia
  • Abnormal/dysplastic white cells - suggestive of myelodysplastic syndrome
  • Immature white blood cells - suggestive of myeloproliferative disorder
  • Hyper segmented neutrophils - suggestive of megaloblastic anaemia
  • Fragmented red blood cells - suggestive of peripheral destruction
• Basic investigations

  • Full blood count
  • Peripheral blood film
  • Liver function tests
  • Iron studies
  • Haematinics: vitamin B12 and folate
  • Bone profile
  • Uric acid
  • Renal function
  • Coagulation
  • Lactate dehydrogenase - sign of cell turn over
  • Reticulocyte count