EUH Morning Report: What is the differential and approach to the patient for Pancytopenia?

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The Bottom Line: “Multiple conditions can present with pancytopenia. When someone shows up with pancytopenia, a complete evaluation is performed to detect the cause of pancytopenia. Bone marrow disorders such as aplastic anemia, myelodysplastic syndrome, acute leukemia, myelofibrosis, megaloblastic anemia, paroxysmal nocturnal hemoglobinuria, and Fanconi anemia can present with pancytopenia.”
“Fanconi anemia is the most common congenital cause of bone marrow failure with an autosomal recessive inheritance pattern. In myelofibrosis, the bone marrow cells are replaced with fibrotic tissue. Malignancies such as lymphoma, multiple myeloma, and hairy cell leukemia can also present with pancytopenia. Non-bone marrow conditions present with pancytopenia include systemic lupus erythematosus and infections (such as parvovirus B19, Epstein Barr virus, HIV, hepatitis, leishmaniasis, tuberculosis, malaria, and histoplasmosis).” (Chiravuri)

Gnanaraj

Approach to diagnostic testing and evaluation:

    In all patients, perform complete blood count with differential to detect pancytopenia and assess disease severity.
    Rule out effects of drugs or toxins based on drug history.

    Tests to rule out or suggest the underlying cause of pancytopenia:

Initial blood tests include:
            peripheral blood smear, which may show characteristic features indicative of the
underlying cause
            reticulocyte count – a low count may indicate bone marrow failure such as aplastic
anemia
            basic metabolic panel and liver function tests
            screening for nutritional deficiency including vitamin B12, folate, and copper
deficiency
            serum lactate dehydrogenase
            serum haptoglobin (DynaMed)

Chiravuri S, De Jesus O. Pancytopenia. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Free Full Text

Gnanaraj J, Parnes A, Francis CW, Go RS, Takemoto CM, Hashmi SK. Approach to pancytopenia: Diagnostic algorithm for clinical hematologists. Blood Rev. 2018 Sep;32(5):361-367 Full Text for Emory Users

DynaMed Pancytopenia – Approach to the Patient EBSCO Information Services. Accessed June 5, 2024.