Pancytopenia: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Signs/symptoms of anemia (e.g. fatigue, dyspnea, tachycardia, pallor) | *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 thrombocytopenia (e.g. [[petechiae]]/[[purpura]], mucosal bleeding, [[GI bleed]], [[hematuria]], [[intracranial hemorrhage]]) | ||
*Signs/symptoms of leukopenia (e.g. recurrent, severe, or opportunistic infection) | *Signs/symptoms of leukopenia (e.g. recurrent, severe, or opportunistic [[infection]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Pancytopenia Causes=== | ===Pancytopenia Causes=== | ||
*[[Acute leukemia]] | *[[Acute leukemia]] | ||
*[[Myelodysplastic syndrome]], myelofibrosis | *[[Myelodysplastic syndrome]], [[myelofibrosis]] | ||
*[[Aplastic anemia]] | *[[Aplastic anemia]] | ||
*Infiltrative disease (e.g. [[lymphoma]], [[multiple myeloma]], metastatic carcinoma) | *Infiltrative disease (e.g. [[lymphoma]], [[multiple myeloma]], metastatic carcinoma) | ||
*[[Paroxysmal nocturnal hemoglobinuria]] | *[[Paroxysmal nocturnal hemoglobinuria]] | ||
*Drugs/treatments (* drugs more commonly associated with pancytopenia) | *Drugs/treatments (*drugs more commonly associated with pancytopenia) | ||
**Bone marrow irradiation* | **Bone marrow irradiation* | ||
**Chemotherapy* (especially anthracyclines, [[methotrexate]]) | **Chemotherapy*(especially anthracyclines, [[methotrexate]]) | ||
**Anti-inflammatories (rituximab*, sulfasalazine*, [[colchicine]], [[azathioprine]], [[methotrexate]]) | **Anti-inflammatories ([[rituximab]]*, sulfasalazine*, [[colchicine]], [[azathioprine]], [[methotrexate]]) | ||
**Antimicrobials ([[chloramphenicol]], [[ | **Antimicrobials ([[chloramphenicol]], [[ganciclovir]], [[penicillin G]]*, [[dapsone]]*, [[quinine]] | ||
**Thiomides ( | **Thiomides ([[propylthiouracil]]*, [[methimazole]]*, carbimazole) | ||
**[[Antipsychotics]] ([[clozapine]]*, [[olanzapine]] | **[[Antipsychotics]] ([[clozapine]]*, [[olanzapine]] | ||
**[[Procainamide]]* | **[[Procainamide]]* | ||
**Cyclophosphamide | **[[Cyclophosphamide]] | ||
**[[Antiepileptics]] ([[phenytoin], [[carbamazepine]], [[phenobarbital]]) | **[[Antiepileptics]] ([[phenytoin]], [[carbamazepine]], [[phenobarbital]]) | ||
*Infection | *Infection | ||
**[[Tuberculosis]] | **[[Tuberculosis]] | ||
**[[AIDS]] | **[[AIDS]] | ||
**Leishmaniasis, brucellosis, histoplasmosis. | **[[Leishmaniasis]], [[brucellosis]], [[histoplasmosis]]. | ||
**Viruses causing aplastic anemia (hepatitis, Epstein-Barr virus, HIV, parvovirus B19) | **Viruses causing [[aplastic anemia]] ([[viral hepatitis]], [[Epstein-Barr virus]], [[HIV]], [[parvovirus B19]]) | ||
*[[Systemic lupus erythematosus]] | *[[Systemic lupus erythematosus]] | ||
*Hypersplenism | *Hypersplenism | ||
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*CBC Findings: Low hemoglobin/hematocrit, platelets, and white blood cell count | *CBC Findings: Low hemoglobin/hematocrit, platelets, and white blood cell count | ||
=== | ===Additional Considerations=== | ||
*Evaluate for causes of pancytopenia | *Evaluate for causes of pancytopenia | ||
**Drug history, infectious work-up, smear, malignancy work-up | **Drug history, infectious work-up, smear, malignancy work-up | ||
*Evaluate for dangerous | *Evaluate for dangerous sequelae | ||
**See evaluation of [[anemia]], [[thrombocytopenia]], [[neutropenia]] | **See evaluation of [[anemia]], [[thrombocytopenia]], [[neutropenia]] | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Heme/Onc]] | |||
Latest revision as of 17:15, 1 October 2019
Background
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)