Pancytopenia

Aka: Pancytopenia, Bicytopenia

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II. Definition

  1. Bicytopenia: decrease in two of three cell lines
    1. May suggest Pancytopenia in development
  2. Pancytopenia: decrease in all blood cell lines
    1. Anemia
    2. Leukocytopenia
    3. Thrombocytopenia

III. Causes: General

  1. Aplastic Anemia
  2. Vitamin B12 Deficiency
  3. Folate Deficiency
  4. Systemic Lupus Erythematosus
  5. Paroxysmal Nocturnal Hemoglobinuria
  6. Severe infection
  7. Brucellosis
  8. Sarcoidosis
  9. Pregnancy
  10. Fanconi's Anemia
  11. Primary Bone Marrow disorder
    1. Multiple Myeloma
    2. Metastatic cancer
    3. Myelofibrosis
    4. Osteopetrosis
  12. Splenic disorder
    1. Lymphoma
    2. Gaucher Disease
    3. Niemann-Pick Disease
    4. Splenomegaly due to congestion
    5. Kala-Azar

IV. Causes: By Marrow Findings

  1. Hypocellular Marrow with Pancytopenia
    1. Aplastic Anemia
    2. Fanconi's Anemia
    3. Copper Deficiency
    4. Other conditions which may cause hypocellular marrow with Pancytopenia
      1. Atypical presentations of Leukemia, Lymphoma or Myelodysplastic Syndrome
      2. Q Fever
      3. Legionnaire's Disease
      4. Mycobacterium
      5. Anorexia Nervosa
  2. Cellular Marrow with Pancytopenia
    1. Primary Bone Marrow disorders
      1. Myelodysplastic Syndrome
      2. Myelofibrosis
      3. Paroxysmal Nocturnal Hemoglobinuria
    2. Malignancy
      1. Bone MarrowLymphoma
      2. Hairy Cell Leukemia
    3. Systemic Conditions
      1. Alcohol Use Disorder
      2. Brucellosis
      3. Folate Deficiency
      4. HIV Infection
      5. Hypersplenism
      6. Leishmaniasis
      7. Sarcoidosis
      8. Sepsis
      9. Systemic Lupus Erythematosus
      10. Tuberculosis
      11. Vitamin B12 Deficiency

V. Signs: Clinical Clues

  1. Splenomegaly
  2. Lymphadenopathy

VI. Labs

  1. Complete Blood Count
    1. Pancytopenia consistent with cell counts as below
  2. Peripheral Smear
    1. Macrocytic Anemia
    2. Reticulocytopenia (Reticulocyte Index <1%)
    3. Thrombocytopenia (Platelet Count <20,000/mm3)
    4. Neutropenia
      1. Absolute Neutrophil Count <500/mm3
      2. ANC <200/mm3 suggests very severe disease

VII. Evaluation

  1. Bone Marrow Biopsy: Normal count or hyperplasia
    1. Findings: Blasts, Dysplasia or Fibrosis
    2. Examples (See causes above)
      1. Myelodysplastic Syndrome
      2. Acute Myeloid Leukemia (AML)
      3. Agnogenic myeloid metaplasia
  2. Bone Marrow Biopsy: Fat infiltration (Hypoplasia)
    1. Acquired Aplastic Anemia or
    2. Fanconi's Anemia
      1. Diepoxybutane induced Chromosome breakage or
      2. Mitomycin-C induced Chromosome breakage

VIII. References

  1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 1449
  2. Saiki in Friedman (1991) Medical Diagnosis, p. 225
  3. Dasgupta (2015) J Lab Physicians 7(2):90-5 +PMID: 26417158 [PubMed]

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