Pancytopenia

Question 1

What is pancytopenia?

Answer 1

A deficiency in blood cells of all lineages (RBC, platelets, granulocytes)
Generally excludes lymphocytes

Question 2

Pancytopenia is caused by reduced production or increased destruction of cells. True/False?

Answer 2

True

Question 3

Fanconi’a anaemia is an inherited marrow failure syndrome. What is the defect?

Answer 3

Failure to repair DNA damage

Question 4

List the main acquired primary bone marrow failures that result in pancytopenia

Answer 4

Aplastic anaemia
Myelodysplasia
Acute leukaemia

Question 5

What happens in aplastic anaemia?

Answer 5

Autoimmune attack against haemopoietic stem cells

Question 6

List the main causes of secondary bone marrow failure

Answer 6

Drugs (chemotherapy, chloramphenicol)
B12/folate deficiency
Infiltration
Infection
Storage diseases

Question 7

What condition is notorious for causing increased destruction of blood cells?

Answer 7

Hypersplenism

Question 8

List some causes of hypersplenism

Answer 8

Splenic congestion (heart failure, hypertension)
Rheumatoid arthritis
Felty’s syndrome
Lymphoma

Question 9

List clinical features of pancytopenia (think anaemia, neutropenia and thrombocytopenia)

Answer 9

Fatigue
Breathlessness
Infection
Bleeding
Purpura, rash

Question 10

List investigations for pancytopenia

Answer 10

Family history
Blood count and film
Guided tests (LFTs, folate/B12, virology, antibodies)
Cytogenetics
Bone marrow aspirate

Question 11

Outline supportive treatment for pancytopenia

Answer 11

Blood transfusion

Prophylactic antibiotics

Question 12

Outline treatment for pancytopenia caused by primary marrow disorder

Answer 12

Chemotherapy
Bone marrow transplant
Immunosuppression

Question 13

Outline treatment for pancytopenia caused by secondary marrow disorder

Answer 13

Stop precipitants
Treat infection
Replace B12/folate