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Pancytopenia

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Definition

Cell Type	Definition	Effects of Pancytopenia
Red Blood Cells (RBCs)	Red blood cells are responsible for carrying oxygen throughout the body.	Anaemia: Fatigue, weakness, shortness of breath, and pallor due to reduced oxygen delivery.
White Blood Cells (WBCs)	White blood cells play a critical role in the immune system, defending the body against infections.	Leukopenia: Increased susceptibility to infections and delayed recovery from illness.
Platelets	Platelets are essential for blood clotting and preventing excessive bleeding.	Thrombocytopenia: Easy bruising, prolonged bleeding, and risk of hemorrhage.

Causes

Bone Marrow Failure: Aplastic anaemia, myelodysplastic syndrome, leukaemia, myelofibrosis
Bone Marrow Infiltration: Metastatic cancer, lymphoma, multiple myeloma
Bone Marrow Suppression: Chemotherapy, radiation, medications (e.g., cytotoxic drugs)
Nutritional Deficiencies: Vitamin B12 deficiency, folate deficiency
Infections: HIV, hepatitis, tuberculosis, sepsis
Autoimmune Diseases: Systemic lupus erythematosus (SLE), rheumatoid arthritis
Hypersplenism: Enlarged spleen (e.g., in cirrhosis or portal hypertension) leading to increased destruction of blood cells
Congenital Conditions: Fanconi anaemia, Shwachman-Diamond syndrome
Toxins: Alcohol, chemical exposure (e.g., benzene), certain drugs

Clinical Features

Anaemia: Fatigue, pallor, weakness, shortness of breath
Thrombocytopenia: Easy bruising, petechiae, bleeding (e.g., gums, nosebleeds, heavy menstrual bleeding)
Leukopenia: Increased susceptibility to infections, recurrent infections
Systemic Symptoms: Fever, weight loss, night sweats (in cases of malignancy or infection)
Splenomegaly: Enlarged spleen in cases of hypersplenism or certain hematological disorders

Diagnosis

Complete Blood Count (CBC): Confirms pancytopenia with reduced levels of red blood cells, white blood cells, and platelets
Peripheral Blood Smear: Assesses the morphology of blood cells for any abnormalities
Bone Marrow Biopsy:
- Essential for determining the underlying cause
- Helps differentiate between bone marrow failure, infiltration, and suppression
Serum Levels: Check for vitamin B12 and folate deficiencies
Infection Screening: HIV, hepatitis panel, and other relevant infectious markers
Imaging: CT or ultrasound to assess for splenomegaly or signs of malignancy
Autoimmune Screening: ANA, rheumatoid factor for underlying autoimmune conditions

Commonest Causes and Management

Common Causes	Clinical Features	Diagnosis	Management
Aplastic Anaemia	Fatigue, pallor Recurrent infections due to leukopenia Easy bruising, bleeding due to thrombocytopenia	Bone marrow biopsy: Hypocellular marrow CBC: Pancytopenia Peripheral blood smear: Normal morphology	Immunosuppressive therapy (e.g., ATG, cyclosporine) Bone marrow transplant Supportive care: Blood transfusions, antibiotics
Leukaemia (Acute/Chronic)	Fatigue, weight loss, fever Recurrent infections Bruising, petechiae Splenomegaly in some cases	Bone marrow biopsy: Hypercellular marrow with blasts CBC: Pancytopenia, blasts on smear Flow cytometry: Abnormal blast markers	Chemotherapy Bone marrow transplant in some cases Supportive care: Blood and platelet transfusions
Myelodysplastic Syndrome (MDS)	Fatigue, weakness Recurrent infections Easy bruising	Bone marrow biopsy: Dysplastic marrow with abnormal maturation CBC: Pancytopenia Cytogenetic studies: Chromosomal abnormalities	Low-intensity chemotherapy (e.g., azacitidine) Bone marrow transplant in younger patients Growth factors (e.g., G-CSF) to support blood counts
Vitamin B12/Folate Deficiency	Fatigue, pallor Glossitis, peripheral neuropathy (B12 deficiency) Bruising due to thrombocytopenia	Serum B12 and folate levels: Low CBC: Pancytopenia, macrocytic anaemia Bone marrow biopsy: Megaloblastic changes	Vitamin B12 or folate supplementation Address underlying causes (e.g., dietary deficiency, malabsorption)
Infections (HIV, Hepatitis, TB)	Fever, weight loss Recurrent infections Hepatosplenomegaly in some cases	Serology: HIV, hepatitis, TB tests CBC: Pancytopenia Bone marrow biopsy: Infiltration by infection	Treat underlying infection (e.g., antivirals for HIV, antibiotics for TB) Supportive care with transfusions if needed
Autoimmune Diseases (SLE, RA)	Fatigue, joint pain (in RA or SLE) Recurrent infections due to leukopenia Bruising, bleeding due to thrombocytopenia	CBC: Pancytopenia ANA, anti-dsDNA (for SLE) Bone marrow biopsy: Marrow infiltration or suppression	Corticosteroids or immunosuppressive therapy (e.g., azathioprine, cyclophosphamide) Supportive care: Blood transfusions Manage underlying autoimmune disease
Hypersplenism	Splenomegaly Anaemia, recurrent infections Easy bruising due to thrombocytopenia	Physical exam: Enlarged spleen Ultrasound or CT: Confirm splenomegaly CBC: Pancytopenia	Treat underlying cause of splenomegaly (e.g., cirrhosis) Splenectomy in severe cases Supportive care: Transfusions

Management

Address Underlying Cause:
- Treat infections with appropriate antimicrobials
- Stop causative medications or toxins
- Treat nutritional deficiencies (e.g., vitamin B12, folate supplementation)
- Manage autoimmune conditions (e.g., corticosteroids for SLE)
- Chemotherapy or bone marrow transplant for malignancies (e.g., leukaemia, myelodysplastic syndromes)
Supportive Care:
- Blood transfusions for symptomatic anaemia
- Platelet transfusions for significant thrombocytopenia
- Growth factors (e.g., G-CSF) to stimulate white blood cell production in some cases
Bone Marrow Transplant: Considered in severe cases of bone marrow failure or malignancies
Splenectomy: May be considered for hypersplenism causing pancytopenia
Infection Prevention: Prophylactic antibiotics or antiviral medications for those at high risk of infections

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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