II. Definition
- Bicytopenia: decrease in two of three cell lines
- May suggest Pancytopenia in development
- Pancytopenia: decrease in all blood cell lines
- Anemia
- Leukocytopenia
- Thrombocytopenia
III. Causes
- Aplastic Anemia
- Vitamin B12 Deficiency
- Folate Deficiency
- Systemic Lupus Erythematosus
- Paroxysmal Nocturnal Hemoglobinuria
- Severe infection
- Brucellosis
- Sarcoidosis
- Pregnancy
- Fanconi's Anemia
- Primary Bone Marrow disorder
- Multiple Myeloma
- Metastatic cancer
- Myelofibrosis
- Osteopetrosis
- Splenic disorder
- Lymphoma
- Gaucher Disease
- Niemann-Pick Disease
- Splenomegaly due to congestion
- Kala-Azar
IV. Signs: Clinical Clues
V. Labs
-
Complete Blood Count
- Pancytopenia consistent with cell counts as below
-
Peripheral Smear
- Macrocytic Anemia
- Reticulocytopenia (Reticulocyte Index <1%)
- Thrombocytopenia (Platelet Count <20,000/mm3)
-
Neutropenia
- Absolute Neutrophil Count <500/mm3
- ANC <200/mm3 suggests very severe disease
VI. Evaluation
-
Bone Marrow Biopsy: Normal count or hyperplasia
- Findings: Blasts, Dysplasia or Fibrosis
- Examples (See causes above)
- Myelodysplastic Syndrome
- Acute Myeloid Leukemia (AML)
- Agnogenic myeloid metaplasia
-
Bone Marrow Biopsy: Fat infiltration (Hypoplasia)
- Acquired Aplastic Anemia or
- Fanconi's Anemia
- Diepoxybutane induced Chromosome breakage or
- Mitomycin-C induced Chromosome breakage
VII. References
- Lee (1999) Wintrobe's Hematology, Lippincott, p. 1449
- Saiki in Friedman (1991) Medical Diagnosis, p. 225