Pancytopenia

Background

Anemia + Thrombocytopenia + Leukopenia

Clinical Features

Signs/symptoms of anemia (e.g. fatigue, dyspnea, tachycardia, pallor)
Signs/symptoms of thrombocytopenia (e.g. petechiae/purpura, mucosal bleeding, GI bleed, hematuria, intracranial hemorrhage)
Signs/symptoms of leukopenia (e.g. recurrent, severe, or opportunistic infection)

Differential Diagnosis

Pancytopenia Causes

Acute leukemia
Myelodysplastic syndrome, myelofibrosis
Aplastic anemia
Infiltrative disease (e.g. lymphoma, multiple myeloma, metastatic carcinoma)
Paroxysmal nocturnal hemoglobinuria
Drugs/treatments (*drugs more commonly associated with pancytopenia)
- Bone marrow irradiation*
- Chemotherapy*(especially anthracyclines, methotrexate)
- Anti-inflammatories (rituximab*, sulfasalazine*, colchicine, azathioprine, methotrexate)
- Antimicrobials (chloramphenicol, ganciclovir, penicillin G*, dapsone*, quinine
- Thiomides (propylthiouracil*, methimazole*, carbimazole)
- Antipsychotics (clozapine*, olanzapine
- Procainamide*
- Cyclophosphamide
- Antiepileptics (phenytoin, carbamazepine, phenobarbital)
Infection
- Tuberculosis
- AIDS
- Leishmaniasis, brucellosis, histoplasmosis.
- Viruses causing aplastic anemia (viral hepatitis, Epstein-Barr virus, HIV, parvovirus B19)
Systemic lupus erythematosus
Hypersplenism
Acute radiation syndrome

Evaluation

CBC Findings: Low hemoglobin/hematocrit, platelets, and white blood cell count

Additional Considerations

Evaluate for causes of pancytopenia
- Drug history, infectious work-up, smear, malignancy work-up
Evaluate for dangerous sequelae
- See evaluation of anemia, thrombocytopenia, neutropenia

Management

See management of anemia, thrombocytopenia, neutropenia
Consider appropriate consults (e.g. heme/onc, infectious disease)

See Also

References

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