Pancytopenia

Question 1

What is pancytopenia?

Answer 1

Decrease in the number of RBC’s, WBC’s and platelets in the peripheral blood flow

Question 2

What are the different causes for pancytopenia?

Answer 2

“Decreased production of blood cells (bone marrow failure, or immune-mediated destruction of blood cells) or non-immune-mediated sequestration in the periphery/spleen. ”-RBCs trapped in spleen:
1. Congenital causes:
- Gaucher’s disease (marrow infiltration, splenomegaly)
- Fanconi’s anaemia (bone marrow failure)
2. Acquired (decreased bone marrow production):
- Cytotoxic chemotherapy
- radiotherapy
- Megaloblastic anaemia
- Bone marrow infiltration
- Myelodysplasia
- Myelofibrosis
- Idiopathic aplastic anaemia
3. Increased/ decreased sequestration:
- liver disease
- Portal hypertension

Question 3

What are the risk factors for pancytopenia?

Answer 3

1. Aplastic Anaemia → type of anaemia caused by bone marrow failure
   - Normochromic, normocytic anaemia
   - Leads to decrease of all cells (pancytopenia) ⇒ ie. leukopenia, anaemia, thrombocytopaenia
2. Acute & Chronic Leukaemia
3. Myelofibrosis
4. Multiple Myeloma → malignancy characterised by plasma cell proliferation
5. Methotrexate → can lead to bone marrow suppression
6. Chemotherapy + Radiotherapy
7. B12 or Folate Deficiency
8. Lymphoma

Question 4

What are the presenting symptoms of pancytopenia?

Answer 4

Symptoms of anaemia/leukopenia/thrombocytopenia → SOB, pale skin, fatigue, weakness, fever, easy bruising, petechiae, purpura, bleeding gums and nosebleeds, recurrent infections 

Question 5

What signs of pancytopenia can be found on physical examination?

Answer 5

1. sign:
   - Leukaemic infiltrates (acute leukaemia) 
   - Jaundiced sclera
   - Tachycardia, oedema, congestive cardiac failure
   - Clubbing (lung cancer) 
   - Tachypnoea (sign of symptomatic anaemia) 
   - Right upper quadrant tenderness (hepatitis) 
   - Lymphadenopathy (infection, lymphoproliferative disorder, HIV disease) 
   - Signs of chronic liver disease 
   - Splenomegaly (infection, myeloproliferative and lymphoproliferative disorders) 
2. Skin examination 
   - Malar rash (SLE) 
   - Purpura/bruising (thrombocytopenia) 

 3. Signs associated with HIV disease 
- Morbilliform rash early 
- Kaposi’s sarcoma, ulcerating nodules later 

Question 6

What investigations are used to diagnose/ monitor pancytopenia?

Answer 6

1. FBC and Blood Smear
2. Bone Marrow Aspiration + Biopsy → see if issue is with bone marrow
   - Look for underlying cause

Question 7

How is pancytopenia managed?

Answer 7

• RBC and Platelet Transfusion
• Bone Marrow/Stem Cell Transplant

Question 8

What complications may arise following pancytopenia?

Answer 8

• excess bleeding if platelets are affected 
• increased risk for infections if white blood cells are affected 
• Severe pancytopenia can be life-threatening.