Pancytopenia
Background
Clinical Features
- Signs/symptoms of anemia (e.g. fatigue, dyspnea, tachycardia, pallor)
- Signs/symptoms of thrombocytopenia (e.g. petechiae/purpura, mucosal bleeding, GI bleed, hematuria, intracranial hemorrhage)
- Signs/symptoms of leukopenia (e.g. recurrent, severe, or opportunistic infection)
Differential Diagnosis
Pancytopenia Causes
- Acute leukemia
- Myelodysplastic syndrome, myelofibrosis
- Aplastic anemia
- Infiltrative disease (e.g. lymphoma, multiple myeloma, metastatic carcinoma)
- Paroxysmal nocturnal hemoglobinuria
- Drugs/treatments (*drugs more commonly associated with pancytopenia)
- Bone marrow irradiation*
- Chemotherapy*(especially anthracyclines, methotrexate)
- Anti-inflammatories (rituximab*, sulfasalazine*, colchicine, azathioprine, methotrexate)
- Antimicrobials (chloramphenicol, ganciclovir, penicillin G*, dapsone*, quinine
- Thiomides (propylthiouracil*, methimazole*, carbimazole)
- Antipsychotics (clozapine*, olanzapine
- Procainamide*
- Cyclophosphamide
- Antiepileptics (phenytoin, carbamazepine, phenobarbital)
- Infection
- Tuberculosis
- AIDS
- Leishmaniasis, brucellosis, histoplasmosis.
- Viruses causing aplastic anemia (viral hepatitis, Epstein-Barr virus, HIV, parvovirus B19)
- Systemic lupus erythematosus
- Hypersplenism
- Acute radiation syndrome
Evaluation
- CBC Findings: Low hemoglobin/hematocrit, platelets, and white blood cell count
Additional Considerations
- Evaluate for causes of pancytopenia
- Drug history, infectious work-up, smear, malignancy work-up
- Evaluate for dangerous sequelae
- See evaluation of anemia, thrombocytopenia, neutropenia
Management
- See management of anemia, thrombocytopenia, neutropenia
- Consider appropriate consults (e.g. heme/onc, infectious disease)