Department of infectious diseases and clinical microbiology. Evaluation and management of chronic pancytopenia american. Due to the easy availability and cost effectiveness, tmpsmx is one of the medications commonly used for treatment of skin and soft tissue in patients with methicillinresistant staphylococcus aureus. Pancytopenia is present in approximately 50% of patients with hairy cell leukemia at diagnosis. Dr vishu p bhasin dcp resident, santosh medical college 2. Jul, 2015 one of the major challenges in pediatric hematology is the correct diagnosis of patients with pancytopenia and hypocellular bm. A thoughtful history and physical examination along with focused laboratory studies are required to establish a diagnosis and select proper management. Diagnostic documentation for oncology patients acp. Association of epsteinbarr virus with human neoplasia. This approach uses findings from the complete blood cell count and the peripheral smear to organize the possible causes of thrombocytopenia into those that affect only platelet count, those that produce both a low platelet count and hemolytic anemia, and. The differential diagnosis and bone marrow evaluation of new onset pancytopenia.
After a proper diagnosis reveals the reason behind the symptoms the person is suffering from, a treatment is carried out. The purpose of this paper is to record a case of pancytopenia due to disseminated tuberculosis, and again to draw attention to the difficulties encountered in diagnosis. Pancytopenia is a reduction in the number of red blood cells, white blood cells, and platelets in the peripheral blood below the lower limits of the ageadjusted normal range for healthy people. Pancytopenia is a relatively common phenomenon encountered in clinical practice. Its presentation as a pancytopenia is even more rare.
Jan 01, 20 provide the general differential diagnosis of newonset pancytopenia in both children and adults. Apr 03, 2011 mnemonic for causes of pancytopenia cytopenia is a reduction in the number of each type of peripheral blood cell. Mar 01, 2016 pancytopenia is characterized by a decreased number of at least two blood cell lines. Gd type 1 is the most common form of this condition, and patients with this pathology present with unexplained cytopenias, in addition to hepatosplenomegaly, bone involvement, and in other cases neurological disorders. Pancytopenia increases your risk for infection and. Reversible causes such as nutritional deficinecies, immune disorders, drugrelated can be treated effectively. Although often normocytic, mild macrocytosis can also be observed in association with stress erythropoiesis and elevated fetal hemoglobin levels. Pancytopenia is a common hematological problem with an extensive differential diagnosis, and still the optimal diagnostic approach to pancytopenia remains undefined. If the underlying condition is found to be pancytopenia, the treatment usually consists of medications. Pernicious anemia is a condition that results in deficient production of intrinsic factor in the parietal cells of the stomach. Fever, emesis, abdominal pain, and pancytopenia in a 16year. Pancytopenia due to hemophagocytosis in patients with brucellosis.
The differential diagnosis for fever and abdominal pain in a child who has recently emigrated from southeast asia is broad and includes such infectious etiologies as malaria, typhoid fever, brucellosis, viral hepatitis, and dengue fever. Evaluation of pancytopenia differential diagnosis of. Sle can present with pancytopenia when all the three cell lines are affected, however it. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by t. Ards stands for acute respiratory distress syndrome.
Dec 05, 2018 aplastic anemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. Pancytopenia definition of pancytopenia by the free. The diagnostic approach is the same as for pancytopenia. Women with the condition tend to have heavy periods, since they actually have a bleeding disorder. Unnecessary hysterectomies due to undiagnosed bleeding disorder in women. We present case of two syrian refugee infants with severe vitamin b12 deficiency with pancytopenia, hepatosplenomegaly and. Methotrexate mtx was originally formulated as one of the first antitumour drugs due to its ability to alter folate metabolism, which renders it to be an antiproliferative agent. Early diagnosis with genetic testing is crucial for management, preventive care and screening of other family members. A unifying diagnosis for pancytopenia, fever, hypoglycemia.
Epsteinbarr virus ebv infectious mononucleosis mono. It is therefore the combination of anaemia, leukopenia, and thrombocytopenia. Pdf pancytopenia means decrease in all three cell lines. Other features which may be found on examination are short stature, structual abnormalities. Pancytopenia may progress acutely, such as with decreased blood cell counts in fulminant sepsis, disseminated intravascular coagulation, or rapid hemolysis. The evaluation of a patient with pancytopenia requires a comprehensive approach and identifying the underlying cause can be challenging given the wide range of etiologies including drugs, autoimmune conditions, malignancies, infections, hemophagocytosis, and inheritable conditions. An abnormally low level of red blood cells, white blood cells, and platelets in the circulating blood. However, as most cases are due to maternal insufficiency, it is mainly seen in breastfed infants especially when the mothers socioeconomic status is low and the nutrition is not adequate. Pancytopenia is a deficiency of all types of blood cells, including white blood cells, red blood cells, and platelets.
Alternatively, pancytopenia may evolve insidiously over weeks to months. Once infections and other more frequent conditions resulting in a transient suppression of hematopoieisis have been excluded, the main differential diagnosis includes saa, hypoplastic mds, and ibmfs, such as fa and dc. A reduction in all 3 types of cellular components in peripheral blood is termed pancytopenia and this involves anaemia, neutropenia, and thrombocytopenia. In this case report, we will discuss a case of a patient with druginduced pancytopenia along with the differential diagnosis for pancytopenia of unknown origin and expected finding in each pathology. By contrast, pancytopenia is frequently associated with a hypocellular bone marrow, and the differential diagnosis includes acquired aplastic anemia, myelodysplastic syndrome, inherited bone. Mnemonic for causes of pancytopenia cytopenia is a reduction in the number of each type of peripheral blood cell. Severe afflictions may result in the women receiving a. Patients on high doses of mtx are prone to develop rare complications of myelosuppression and. Pancytopenia is low levels of red blood cells, white blood cells, and platelets. It occurs when your body cannot produce enough blood cells because the bone marrow stem cells that form blood cells do not function normally. From a critical care point, pancytopenia should be managed as a part of a multisystemic complication of myxedema coma, knowledge of which can help guide management for critical care providers.
Modern meded partners with board vitals to bring you up to 100 cat. A 37yearold patient, who was admitted to an infection clinic with signs including fever, elevated liver enzymes and pancytopenia that developed subsequent to cephalexin and dexketoprofen trometamol use. Extrapulmonary tuberculosis can present with various hematological manifestations, including pancytopenia. Pancytopenia in a patient with hypothyroidism endocrinology. During his stay, he showed a spectrum of interesting hematological findings, including severe pancytopenia on peripheral smear, hemophagocytosis, epithelioid cell. Each of these blood cell types has a different job in the body. Almost always indicated in cases of pancytopenia unless cause is otherwise apparent consists of both an aspirate and a trephine biopsy the differential diagnosis is based on the. Aplastic anemia fanconi anemia occurs in ages 2 to 10 years and child may present with thrombocytopenia, leukopenia, pancytopenia, fatigue, spontaneous bruising, mucosal bleeding, fever and rigors. Acute liver injury and pancytopenia subsequent to cephalexin. Pancytopenia definition, causes, symptoms, diagnosis and. It may result from decreased production of blood cells, bone marrow.
Pancytopenia is present in approximately 50% of patients with hcl at diagnosis. Doctor answers on symptoms, diagnosis, treatment, and more. The laboratory diagnosis of pancytopenia is evident by low values of hemoglobin. Pancytopenia is a reduction in the number of rbcs, wbcs and, platelets in the peripheral blood below the lower limits of the. Aplastic anemia differential diagnoses medscape reference.
Platelets stop the bleeding when you are cut or injured. A 25yearold woman with history of irondeficiency anemia and hypothyroidism presented with fatigue and weight loss for 3 weeks. Differential diagnosis of thrombocytopenia without splenomegaly vasculitis intravascular prosthetics thrombotic thrombocytopenia hemolytic uremic syndrome infection viral bacterial rickettsial drugs abnormal bone marrow the patient had thrombocytopenia without splenomegaly. Evaluation of pancytopenia differentials bmj best practice. It is important to recognize that bone marrow involvement by the whipple bacillus is not uncommon.
Druginduced pancytopenia is an intrinsic cause of pancytopenia and is mostly considered a diagnosis of exclusion. May 24, 20 pancytopenia is a common hematological problem with an extensive differential diagnosis, and still the optimal diagnostic approach to pancytopenia remains undefined. Differential diagnosis of hepatitis e virus, cytomegalovirus and epsteinbarr virus infection in patients with suspected hepatitis e. Elevated serum transaminases and pancytopenia related to medication are rarely seen adverse effects that could lead to serious consequences. Lysosomal storage disorders are a rare group of diseases with genetic origin in which gaucher disease gd stands out as the most frequent. Pancytopenia is characterized by a decreased number of at least two blood cell lines. Assessment of pancytopenia differential diagnosis of. Tuberculosis is a major health problem in the developing world.
Pancytopenia could be due to hypersplenism, maturation arrest, hemophagocytic lymphohistiocytosis, or infiltration of the bone. Red blood cells carry oxygen to all the organs and tissues of your body. Aplastic anemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets if only two parameters from the complete blood count are low, the term bicytopenia can be used. Hypothyroidism persisted despite successful antileukemic treatment. However, patientsw with inherited conditions or bone marrow disorders need a detailed workup and treatments may not. Causes causes of pancytopenia inherit ed acquir ed 5 6. Pancytopenia is a reduction in the number of rbcs, wbcs and, platelets in the peripheral blood below the lower limits of the ageadjusted normal range for healthy people. Mar 28, 2012 differential diagnosis of pancytopenia in a child. Practitioners should consider cytauxzoonosis as a differential for cats with any or all of the following signs. A 37yearold patient, who was admitted to an infection clinic with signs including fever, elevated liver enzymes and pancytopenia that developed subsequent to cephalexin and dexketoprofen trometamol use due to acute upper respiratory tract infection was presented in this report. The differential diagnosis and bone marrow evaluation of newonset pancytopenia. Pancytopenia and its cause is always a significant diagnosis that affects severity of illness classification.
Differential diagnosis and bone marrow evaluation of new. Pancytopenia and hypothyroidism in a patient with leukemic i. Diseases resulting in decreased hematopoietic cell production usually require evaluation of bone marrow aspirate or, more often, a bone marrow core biopsy sample to obtain a definitive diagnosis. Trimethoprimsulfamethoxazole tmpsmx is a bacteriostatic antimicrobial medication used for the treatment of a variety of infections and has many reported skin and hematologic side effects. Since the schizogenous phase occurs first, tissue aspirates or biopsies may be a better tool for early diagnosis. After stabilization, he was treated with mopp chemo therapy and patients symptoms gradually improved. Most aml subtypes are distinguished from other related blood disorders by the presence. What are the differential diagnoses for brucellosis. She was admitted recently for hypothyroidism, with a thyroidstimulating hormone level of 209. Diagnosis of extrapulmonary tuberculosis is delayed because the presentation is nonspecific. Richard pinson, md, facp, is a certified coding specialist and cofounder of hcq consulting in houston. Felv, fiv, parvovirus, toxoplasmosis, ehrlichiosis and fip are potential causes. White blood cells help your body fight infection by attacking and killing germs. Acute myelogenous leukemia aml is a malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development.
Apr 02, 2017 the differential diagnosis and bone marrow evaluation of new onset pancytopenia. Mar 10, 2018 modern meded partners with board vitals to bring you up to 100 cat. Megaloblastic anaemia due to vitamin b12 deficiency is rare in childhood. Hypothyroidism is common and should be considered as part of the differential diagnosis in patients with abnormal hematologic parameters. Causes and risk factors in about half the cases of pancytopenia, the origin is unknown or idiopathic. In the presence of lymphadenopathy and pancytopenia, clinicians should think of whipples disease as a differential diagnosis apart from lymphoma or. Classically, the higher dosage is administered via parenteral route, in a cyclical fashion, to achieve antitumour effects. It is therefore the combination of anemia, leukopenia, and thrombocytopenia. In most cases of pancytopenia, referral to a hematologist will be important for purposes of. Or you can use these differential diagnosis mnemonics and study smarter.
This process of determining what is the basic problem is called a differential diagnosis. Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes. You can memorize the differential diagnosis as a medical student, nursing student, or pa student. We suggest that followup of thyroid function and histology should be incorporated in the followup of rare patients with acute lymphoblastic leukemia. Pancytopenia is a common hematological problem with an extensive differential diagnosis and is a challenging. How to create a differential diagnosis part 2 of 3 duration. Leukemic infiltration of the thyroid should be considered as a differential diagnosis in patients with hypothyroidism, goiter, and pancytopenia. Etiological causes of pancytopenia were categorized as four main groups, including hematological diseases in 94 patients 37. A schemebased approach, supported by a simple mnemonic, can narrow the broad differential diagnosis of thrombocytopenia. Nursing diagnosis for pancytopenia answers on healthtap. Early diagnosis and treatment may be associated with improved prognosis. Martinmoreno s, sotoguzman o, bernaldodequiros j, et al.
One of the major challenges in pediatric hematology is the correct diagnosis of patients with pancytopenia and hypocellular bm. Agents such as griseofulvin particularly in fiv positive cats, chloramphenicol and some chemotherapy agents can also induce pancytopenia. It is considered most severe when due to chemotherapy or other drugs. Pancytopenia can be associated with a multitude of disease states, some of which are life threatening. Pancytopenia usually presents with symptoms of bone marrow failure such as pallor, dyspnea, bleeding, bruising and increased tendency to infections2. Pancytopenia is a condition in which a persons body has too few red blood cells, white blood cells, and platelets. This is in contrast to the western world, where leukemia is the leading cause of pancytopenia.
Differential white count was remarkable for neutrophils 56%, lymphocytes 30%, monocytes %, metamyelocytes 1%, and few nucleated red blood cells. Table 1071 differential diagnosis of pancytopenia harrisons textbook of internal medicine major causes of pancytopenia secondary to bone marrow failure uptodate major causes of acquired aplastic anemia uptodate despite cellular bm. The treatment of pancytopenia is done by finding out the real cause of the symptoms. The differential diagnosis of feline anaemia wsava2006 vin.
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