Pancytopenia is defined as anemia typically nonregenerative, neutropenia, and thrombocytopenia. The recommended approach set out in this article incorporates clinical and pathophysiological considerations, red cell characteristics, and bone marrow activity. Dr vishu p bhasin dcp resident, santosh medical college 2. Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets. An abnormally low level of red blood cells, white blood cells, and platelets in the circulating blood. As stated earlier, initial lab values support the possibility of the patient having developed pancytopenia secondary to dic from sepsis prior to admission.
Red blood cells carry oxygen to all the organs and tissues in your childs body. Sepsis, tuberculosis, or fungal infection can cause pancytopenia. While this may seem like an oversimplification, the recognition of these patterns will usually get the clinician very close to the final diagnosis. Cyclic neutropenia is a periodic neutropenia occurring every 25 weeks associated with mild illnesses that are related to the nadir of the neutrophil count. Rarely, drugs antibiotics, blood pressure medication, heart medication.
If only two parameters from the complete blood count are low, the term bicytopenia can be used. Many diseases affect production of these cells by bone marrow resulting into pancytopenia i. It includes deficiency of erythrocytes, leukocytes, platelets, and even reticulocytes. Each of these blood cell types has a different job in the body. It is often discovered incidentally when it is often discovered incidentally when obtaining a complete blood count. Pancytopenia in a patient with graves disease med j malaysia vol 68 no 4 august 20 373 achieved euthyroid status with either antithyroid medication or radioiodine therapy.
Results of this study indicate that feline pancytopenia has multiple causes and that the prognosis is dependent on the cause of the pancytopenia. Pancytopenia is not a disease but a triad of findings that may result from a number of disease processes. By doing so, i hope that im residents will enjoy medicine, and medical students will find interest in internal medicine. Dyspnea, pancytopenia, and splenomegaly mdedge family medicine. Exceptions are severe bacterial sepsis which can result in anemia of inflammatory disease, severe neutropenia with a left shift. In this case report, we will discuss a case of a patient with druginduced pancytopenia along with the differential diagnosis for pancytopenia of unknown origin and expected finding in each pathology. Identifying whether the pancytopenia is caused by a production disorder or a consumption disorder or a combination of both is a key step in both diagnosing the cause and for management of the patient. Such an approach will help to differentiate the disorder from scn that may at times share the same elane mutation. Abstractpancytopenia is a health condition in which there is a reduction in the amount of leucocytes, erythrocytes and thrombocytes. Hepatosplenomegaly in a young child can be an ominous physical finding, potentially representing a metabolic, malignant, or infectious process. Pancytopenia is low levels of red blood cells, white blood cells, and platelets. Red blood cells carry oxygen to all the organs and tissues of your body. This blood cell disorder is seen in many hematological diseases, especially in megaloblastic anemia. Newonset pancytopenia outside this setting, in both children and.
Cytotoxic therapies, including myeloablative radiation therapy and chemotherapy, are common, but predictable, causes of pancytopenia in patients being treated systemically for neoplasia. A 56yearold man with histologically and bacteriologically proved disseminated tuberculosis in association with pancytopenia responded to antituberculosis chemotherapy with bacteriologic cure of his tuberculosis and concomitant resolution of the pancytopenia. Pdf on mar 31, 2017, murtaza kamal and others published approach to pancytopenia find, read and cite all the research you need on researchgate. Hence, in this case, the pancytopenia may be due to dic related to sepsis or a combination of initial dic, exacerbated by drug toxicity to either vancomycin, ceftriaxone or cefepime. Iatrogenic causes of pancytopenia include chemotherapy for malignancies if the drug or drugs used cause bone marrow suppression. Pancytopenia approach pancytopenia is a reduction in the number of red cells, white cells neutrophils and platelets in the peripheral blood below the lower limits of the ageadjusted normal range for healthy people. Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach. In this case report, we will discuss a case of a patient with druginduced pancytopenia along with the differential diagnosis for pancytopenia of unknown. Case report of an adolescent male with unexplained. Druginduced pancytopenia is an intrinsic cause of pancytopenia and is mostly considered a diagnosis of exclusion. Pancytopenia is a disorder associated with decrease in number of all three major formed. It is imperative to establish the diagnosis of cyclic neutropenia by serial differential white counts at least 3 times per week for a minimum of 6 weeks to observe at least 2 neutrophil nadirs. Approach to pancytopenia moderator dr vishal gupta. Pancytopenia medigoo health medical tests and free.
Postulated mechanisms of pancytopenia include reduced production of hematopoietic. Learn pancytopenia with free interactive flashcards. The sole purpose of this website is to help internal medicine residents, medical students, and attendings to learn and teach medicine at its best. A howling cause of pancytopenia the approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patients case in an approach typical of a morning report. We present the case of a 5monthold girl who had fever, hepatosplenomegaly, and hematologic abnormalities at the initial examination. Cytopenia is a reduction in the number of each type of peripheral blood cell. The approach to the patient with newonset pancytopenia is complex and includes an extensive clinical and laboratory evaluation with bone marrow examination. In the treatment of pancytopenia these stem cells are used so that the body can produce normal cells. The evaluation of a patient with pancytopenia requires a comprehensive approach and identifying the underlying cause can be challenging given the wide. Pancytopenia is a relatively common hematological entity.
A 14yearold female with fever, rash, lymphadenopathy, and. This syndrome can range from mild cutaneous rash to drug reaction with eosinophilia and systemic symptoms that include fever, rash, lymphadenopathy, pancytopenia, and involvement of multiple internal organs. Pancytopenia definition of pancytopenia by the free. Differentiation among causes of pancytopenia requires a systematic approach that includes elimination of infectious and drug. Drugstreatments drugs more commonly associated with pancytopenia bone marrow irradiation chemotherapyespecially anthracyclines, methotrexate antiinflammatories rituximab, sulfasalazine, colchicine, azathioprine, methotrexate antimicrobials chloramphenicol, ganciclovir, penicillin g, dapsone, quinine. If someone is pancytopenic, all cell lines are low. We use this pattern recognition approach to neuropathic disorders routinely in our patients, and we suspect many clinicians use a similar approach without being aware of it.
White blood cells help your childs body fight infection by attacking and killing germs. A structured approach to the diagnosis of thrombocytopenia involves an integration of clinical findings and appropriate support from the laboratory and other medical disciplines. Treatment of a disorder that causes pancytopenia eg, chemotherapy for an underlying lymphoma may further exacerbate cytopenias. The evaluation of a patient with pancytopenia requires a comprehensive approach and identifying the underlying.
We report a case of a 17yearold male with sjs and severe pancytopenia. Dec 08, 2012 thrombocytopenia in pregnancy deserves special consideration because of the possible consequences on the fetus. Understanding the causes of pancytopenia in children and how to distinguish these causes and make a diagnosis is a large part of understanding clinical. Hiv infection can also result in pancytopenia from the infection itself, superimposed infections, or medications used to treat the infection. Herbal approach is one of the areas from where newer drugs can be found for the treatment of pancytopenia. Cureus trimethoprimsulfamethoxazole induced pancytopenia. A retrospective study of feline pancytopenia springerlink. Finding an abdominal mass on a child can be alarming to both the parents and pediatrician.
Pancytopenia should be considered a primary bone marrow failure until proven otherwise. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Thrombocytopenia american academy of family physicians. Pancytopenia is defined as lack of all types of blood cells. Cureus pancytopenia as a consequence of sepsis and.
However the approach to manage patients with pancytopenia in the current era of genomics is not well defined in the literature and is widely variable in practice. Thrombocytopenia is defined as a platelet count of less than 150. Similar to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. This association has been generally believed to have a nearly 100 percent mortality. An improved diagnostic approach to ascites jama internal. Pancytopenia is a reduction in the number of rbcs, wbcs and, platelets in the peripheral blood below the lower limits of the. Pancytopenia in a patient with stevensjohnson syndrome.
Aplastic anemia market revenueken research aplastic anemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. White blood cells help your body fight infection by attacking and killing germs. In this issue of cme, the first of two parts on anaemia. On conclusion, aplastic anemia was the most common cause of pancytopenia in our study predominantly affecting young adult males. The main causes of pancytopenia are aplastic anemia, hyper. Pancytopenia is a condition in which a persons body has too few red blood cells, white blood cells, and platelets. Fever, hepatosplenomegaly, and pancytopenia in a 5monthold. Currently, bone marrow stimulant drugs like epoetin alfa epogen, procrit, filgrastim neupogen, pegfilgrastim neulasta, sargramostim leukine, prokine are given for the treatment of cytopenia.
This is a decrease in all the cell lines of your blood. Pancytopenia is a common hematological problem with an extensive differential diagnosis, and the optimal diagnostic approach to pancytopenia remains undefined. Symptoms include fatigue, pale skin, rapid or irregular heart rate, shortness of breath with exertion, nosebleeds and bleeding gums, prolonged bleeding from cuts, skin rash, dizziness and headache. Pancytopenia is a common indication for bone marrow examination and can have numerous causes. Version version download 115 stock quota total files 1 file size 255.
A reduction in all 3 types of cellular components in peripheral blood is termed pancytopenia and this involves anaemia, neutropenia, and thrombocytopenia. A howling cause of pancytopenia journal of hospital medicine. Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination, or detected on abdominal imaging. Approach to the adult with pancytopenia view in chinese one cause of pancytopenia. Thrombocytopenia in pregnancy deserves special consideration because of the possible consequences on the fetus. How to approach neutropenia hematology american society. Platelets stop the bleeding when you are cut or injured. Differential diagnosis and bone marrow evaluation of new. An improved diagnostic approach to ascites has recently been described. The most unique finding was thrombocytopenia, which leads to most of the complications in our patient. Because the differential diagnosis for newonset pancytopenia encompasses many diseases across several medical subspecialties, a thorough history and physical exam are necessary to form a tailored clinical approach. Approach to the patient with ascites differential diagnosis ascites refers to the pathologic accumulation of fluid within the peritoneal cavity. Iatrogenically pancytopenia is caused by some antibiotics and anti.
The prevalence of pancytopenia as a unit only in sjsten has a handful of reported cases. Pancytopenia is a reduction in the number of rbcs, wbcs and, platelets in the peripheral blood below the lower limits of the ageadjusted normal range for healthy people. Causes of pancytopenia normal adult marrow produces about 170x109 rbc 100x109 neutrophils 200x109 platelets daily defects in the stem cells or in the stroma or microenvironment of bone marrow can lead to bone marrow failure and pancytopenia. Approach to the patient with ascites differential diagnosis. Differentiation of the various causes of pancytopenia requires a systematic approach that includes evaluation of infectious, druginduced, and immunemediated causes, and examination of bone marrow. It is important to establish a cause for its development and to initiate a rational treatment regimen to avoid some. Pancytopenia is a common occurrence in pediatric patients.
It is a striking feature of many serious and lifethreatening illnesses, ranging from simple druginduced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. Dyspnea, pancytopenia, and splenomegaly mdedge family. Anticonvulsant hypersensitivity syndrome is a rare adverse drug reaction associated with aromatic anticonvulsant drugs. Jan 01, 20 pancytopenia is a common indication for bone marrow examination and can have numerous causes. The evaluation of a patient with pancytopenia requires a comprehensive approach and identifying the underlying cause can be challenging given the wide range of etiologies including drugs, autoimmune conditions, malignancies, infections, hemophagocytosis, and inheritable conditions. A retrospective study of canine pancytopenia weiss. The diagnostic approach to an adult patient with pancytopenia will be discussed here. Doctor answers on symptoms, diagnosis, treatment, and more. Pancytopenia increases your risk for infection and. The term implies that the bone marrow is responsible for the cytopenias, with very few extramedullary diseases producing this constellation of hematologic abnormalities. Choose from 41 different sets of pancytopenia flashcards on quizlet.
Pancytopenia is a relatively common phenomenon encountered in clinical practice. The pancytopenic condition is observed in treatment of diseased conditions like thalassemia and hepatitis c. Survival of a patient with pancytopenia and disseminated. Though acute leukemias and bone marrow failure syndromes are usual causes of pancytopenia, etiologies such as infections and megaloblastic anemia also contribute. The diagnostic approach is the same as for pancytopenia. Pancytopenia is a common hematological problem with an extensive differential diagnosis, and still the optimal diagnostic approach to pancytopenia remains undefined. Bicytopenia is commonly the result of two pathologies or represents a stage in a developing pancytopenia. Fundus photographs of a 35yearold woman with pancytopenia. Aplastic anemia is also a hematological disease characterized by bone marrow hypoplasia and pancytopenia 1.