Flashcards in this deck (15)

• What is the definition of pancytopenia?

  Hb < 12–13 g/dL ANC < 1800/µL Platelets < 150,000/µL
  medicine definitions
• What are the red-flag signs/symptoms for urgent stabilization in pancytopenia?

  • Altered mental status
  • Hypotension
  • Febrile neutropenia
  • Severe anemia
  • Suspected TMA
  medicine symptoms
• What do chronic cytopenias or congenital abnormalities suggest in stable pancytopenia?

  Inherited bone marrow failure syndromes, refer for hematology + genetics
  medicine diagnosis
• What are key inherited BM failure syndromes to consider in chronic pancytopenia?

  • Fanconi anemia: short stature, café-au-lait, skeletal anomalies
  • Dyskeratosis congenita: early graying, pulmonary fibrosis
  • GATA2 deficiency: unusual infections
  • Shwachman-Diamond: skeletal, pancreatic insufficiency
  • Wiskott-Aldrich: eczema, infections, low IgM
  medicine syndromes
• What are the first labs to order in pancytopenia with suspected acquired etiology?

  CBC with diff, retic count, peripheral smear, BMP, LFTs, LDH, ESR, CRP, iron panel, PTT/PT
  medicine tests
• What smear findings help distinguish causes of pancytopenia?

  • Leukoerythroblastic: BM infiltration/sepsis
  • Blasts: AML/ALL
  • Hypersegmented neutrophils: B12/folate deficiency
  • Atypical lymphocytes: EBV, CMV
  • Schistocytes: DIC, TMA
  medicine smear_findings
• Which drug classes commonly cause pancytopenia?

  • Antiseizure: carbamazepine, levetiracetam
  • Antibiotics: chloramphenicol, linezolid
  • NSAIDs
  • Antithyroid: PTU, methimazole
  • Psych: lithium, valproate
  • Immunosuppressants: chemotherapy, radiation
  medicine drugs
• What are the advanced labs done for inconclusive pancytopenia tests?

  1. Nutritional: B12, folate, Cu, Zn, MMA
  2. Infectious/autoimmune: HIV, EBV, CMV, HLH, ANA
  3. Flow cytometry: CD55/59, leukemia markers
  medicine advanced_testing
• What are the major mechanisms of pancytopenia in the differential?

  • ↓ Production (BM failure)
  • ↑ Destruction ± Production (autoimmune, HLH)
  • Sequestration (hypersplenism)
  medicine mechanisms
• What nutritional deficiencies cause ↓ BM production?

  Severe caloric restriction, vitamin B12, folate, copper, zinc
  medicine nutrition
• What are features of hypoplastic vs hypercellular BM?

  • Hypoplastic BM: Aplastic anemia, viral infection, radiation, myelofibrosis
  • Hypercellular BM: Leukemia, MDS, HLH, metastatic disease
  medicine bone_marrow
• What diseases lead to peripheral destruction of cells in pancytopenia?

  • Autoimmune: Evans syndrome
  • TMA: DIC, TTP, HUS
  • Infection: HLH
  medicine pancytopenia diseases
• What conditions cause splenic sequestration of blood cells?

  • Portal HTN
  • Cirrhosis
  • Malaria
  • Sarcoidosis
  • Lymphoma
  • Storage diseases
  medicine spleen conditions
• What signs suggest splenic sequestration as a cause?

  • Splenomegaly
  • Thrombocytopenia
  • Anemia
  medicine spleen signs
• What is the final step if the cause remains unclear despite initial workup?

  • Bone marrow biopsy
  medicine diagnosis procedures