Causes of Pancytopenia
3. Sequestration in spleen (easy to rule out)
Occurs when RBC are sequestered in the spleen. Usually, this will not be noticeable or palpable until the spleen is roughly twice its normal size.
Causes of Production Problems
1. Stem cell damage or suppression
2. Marrow infiltration
3. Nutritional deficiency
Causes of Normocytic Anemia
- Acute blood loss
- Early iron deficiency
- Anemia of chronic disease
- Bone marrow aplasia/suppression/infiltration
- Renal failure
- Endocrine dysfunction
Differential Diagnosis of Normocytic Anemia
1. Anemia of chronic disease
4. Marrow failure
Gold Standard for Diagnosis
Bone marrow biopsy.
Cellular Concentration in the Bone Marrow
Should be typically 100% - age
For example, a 20 year old should have approximately 80% cellularity in the bone marrow, while a 60 year old should have approximately 40% cellularity.
Severe Aplastic Anemia
Characterized by bone marrow cellularity less than 25%.
Absolute Neutrophil Count (ANC)
The typical range is 1.5 - 8.0
Less than 0.5 and you will see increased frequencies of infections. When it becomes less than 0.2 is very bad as it can lead to spontaneous infections from bacteria in your mouth and intestinal tract.
Normal Platelet Count
Platelets less than 20 is bad and tends to result in spontaneous bleeds.
Inherited Causes of Marrow Aplasia
- Fanconi's anemia (DNA repair problems)
- Scwachman-Diamond syndrome
A disease in which the bone marrow and the blood stem cells that reside there are damaged. This causes a deficiency of all three blood types (RBC, WBC, and platelets) known as pancytopenia.
Can be inherited or acquired. Can be caused by drugs, radiation, immune attack on the bone marrow.