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What's pancytopenia?
Its combination of anemia , leukopenia and
thrombocytopenia
1.HB < 10 g/dL
2.Leukocyte count < 4000/u...
What's causes of
pancytopenia?
 Bone marrow failure : aplastic anemia
 Bone marrow infiltration :
Acute leukemia
Myelo...
 Ineffective haematopoiesis
Megaloblastic anaemia
AIDS
 Peripheral pooling / destruction
Hypersplenism: portal hypert...
What's approach to
thrombocytopenia?
 History
 Examination
 CBC & blood film
 BM aspiration & biopsy
 Other specific ...
History
 Duration of symptom
Long (MDS)
Short (aplastic anemia)
 History of transfusion
 History of hemoglobinurea
 ...
 Weight loss , fever ( Inflammatory or
malignancy)
 Jaundice ( Hepatitis B or C)
 Joint pain (SLE)
 History of blood l...
General examination
 Eye examination: retinal hemorrhage
leukemic infiltrations
 oral examination : oral petechaie
stoma...
 Abdominal examination : organomegaly
lymphadenopathy
 skin examination : malar rash
purpura
hypo or
hyperpigmentation
...
Pancytopenia + Absent thumb
+Child
 Pancytopenia + Back pain +
Hypercalcemia
(multiple myeloma)
 Pancytopenia + Malar rash or GN = SLE
 pancytopenia + HSM...
Blood Film
1.RBC morphology ( size & shape)
2.WBC and RBC precursor
3.Platelets count & size
4.Abnormal increase or decrea...
Other evaluating test may be
included
 ESR
 Reticulocyte count
 Serum LFTs
 Hepatic serology
 Serum coagulation profi...
Anisocytosis--different sized
RBCs
Poikilocytosis--differently
shaped RBCs
Platelets are small, and
reduced in numbers
Apl...
Macrocytosis
Howel jolly bodies
Basophilic stippling
Hypersegmented Neutrophil
Megaloblastic anemia
Tear drop cells
Hypogranular neutrophils
Pseudo pelger Heut Anomaly
Giant platelets
MDS
 The characteristic peripheral blood
morphologic feature in multiple
myeloma is:
A. Cytotoxic T cells
B. Rouleaux formati...
True or false?
 In blood film normal platelets count
rules out aplastic anemia
 True
Bone Marrow Examination
Almost always indicated in case
pancytopenia unless cause is apparent.
Both aspiration and biopsy ...
True or false?
 Bone marrow examination is required
in diagnosis of Megaloblastic anemia
 False
The differential diagnosis of pancytopenia
are based on cellularity of bone marrow :
Hypocellular: excessive amount of fa...
Hypercellular
Causes of Hypocellular BM
1.Aplastic anemia
2.Hypoblastic MDS
3.Cytotoxic agent & radiotherapy
Causes of Hypercellular BM with
primary marrow disorders
1.Acute leukemia / lymphoma
2. Hairy cell leukemia
3. Myelofibros...
Causes of Hypercellular BM with
systemic disorders
1.Metastatic solid tumor
2. hypersplenism
3.Megaloblastic anemia
4. Inf...
Pancytopenia +markedly
Hypocellular scattered mature
lymphocytes
aplastic anemia
Pancytopenia + Hypercellular
BM
Infiltration by RS cells HL
Pancytopenia + Hypercellular
B.M + old age
MDS
Pancytopenia + Hypercellular
marrow
Infiltration with malignant cells (Metastasis)
Specific investigations
 Megaloblastic anemia: Vit.B12 , Folate
assay
 Multiple myeloma :
Imunoelectrophoresis
 PNH: Fl...
Pancytopenia
Pancytopenia
Pancytopenia
Pancytopenia
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Pancytopenia

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Definition & approach of pancytopenia

Published in: Health & Medicine
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Pancytopenia

  1. 1. What's pancytopenia? Its combination of anemia , leukopenia and thrombocytopenia 1.HB < 10 g/dL 2.Leukocyte count < 4000/ul Absolute Neutrophil count <1500/uL 3.Platelet count < 150,000 uL
  2. 2. What's causes of pancytopenia?  Bone marrow failure : aplastic anemia  Bone marrow infiltration : Acute leukemia Myeloma Lymphoma Carcinoma MDS
  3. 3.  Ineffective haematopoiesis Megaloblastic anaemia AIDS  Peripheral pooling / destruction Hypersplenism: portal hypertension , felty's syndrome , malaria , Myelofibrosis SLE
  4. 4. What's approach to thrombocytopenia?  History  Examination  CBC & blood film  BM aspiration & biopsy  Other specific investigation
  5. 5. History  Duration of symptom Long (MDS) Short (aplastic anemia)  History of transfusion  History of hemoglobinurea  Dietary history  Exposure to drugs : anti cancer , Abs , anti thyroid (aplastic anemia)  Barbiturates , phenytoin ( B12, Folic acid)  Chemotherapy , radiation ( MDS , AML)
  6. 6.  Weight loss , fever ( Inflammatory or malignancy)  Jaundice ( Hepatitis B or C)  Joint pain (SLE)  History of blood loss
  7. 7. General examination  Eye examination: retinal hemorrhage leukemic infiltrations  oral examination : oral petechaie stomatitis / chelitis gum hyperplasia oral candidiasis  Respiratory examination : clubbing tachypnea
  8. 8.  Abdominal examination : organomegaly lymphadenopathy  skin examination : malar rash purpura hypo or hyperpigmentation  Musculoskelatal system : short stature synovitis abnormal thumb
  9. 9. Pancytopenia + Absent thumb +Child
  10. 10.  Pancytopenia + Back pain + Hypercalcemia (multiple myeloma)  Pancytopenia + Malar rash or GN = SLE  pancytopenia + HSM = Leukemia
  11. 11. Blood Film 1.RBC morphology ( size & shape) 2.WBC and RBC precursor 3.Platelets count & size 4.Abnormal increase or decrease granulation in Neutrophil 5. Hypo / hypersegmented Neutrophil
  12. 12. Other evaluating test may be included  ESR  Reticulocyte count  Serum LFTs  Hepatic serology  Serum coagulation profile, bleeding time, fibrinogen, and D-dimer  Serum B12 and folate  HIV test
  13. 13. Anisocytosis--different sized RBCs Poikilocytosis--differently shaped RBCs Platelets are small, and reduced in numbers Aplastic anemia
  14. 14. Macrocytosis Howel jolly bodies Basophilic stippling Hypersegmented Neutrophil Megaloblastic anemia
  15. 15. Tear drop cells Hypogranular neutrophils Pseudo pelger Heut Anomaly Giant platelets MDS
  16. 16.  The characteristic peripheral blood morphologic feature in multiple myeloma is: A. Cytotoxic T cells B. Rouleaux formation C. Spherocytosis D. Macrocytosis
  17. 17. True or false?  In blood film normal platelets count rules out aplastic anemia  True
  18. 18. Bone Marrow Examination Almost always indicated in case pancytopenia unless cause is apparent. Both aspiration and biopsy are indicated. Specifically, bone marrow aspirate permits examination of: • Cytology (megaloblastic change, dysplastic changes, abnormal cell infiltrates) • Immunophenotyping : antigen or marker on cells surfaces e.g ( leukemias, lymphoproliferative disorders) • Cytogenetics : structure of chromosome (myelodysplasia, leukemias, lymphoproliferative disorders).
  19. 19. True or false?  Bone marrow examination is required in diagnosis of Megaloblastic anemia  False
  20. 20. The differential diagnosis of pancytopenia are based on cellularity of bone marrow : Hypocellular: excessive amount of fat cells Normocellular: 50-70% hematopoietic cells & 30-50% fat Hypercellular: 80-100% cells with little
  21. 21. Hypercellular
  22. 22. Causes of Hypocellular BM 1.Aplastic anemia 2.Hypoblastic MDS 3.Cytotoxic agent & radiotherapy
  23. 23. Causes of Hypercellular BM with primary marrow disorders 1.Acute leukemia / lymphoma 2. Hairy cell leukemia 3. Myelofibrosis 4.PNH 5.Mutiple myeloma 6. Mylodysblastic leukemia
  24. 24. Causes of Hypercellular BM with systemic disorders 1.Metastatic solid tumor 2. hypersplenism 3.Megaloblastic anemia 4. Infection (T.B ,kala azar, brucellosis) 5. Overwhelming infections 6. Alcohol 7. Autoimmune disorders- SLE, Sjogren’s 8. Sarcoidosis 9. Storage disease- Gaucher, Niemann- pick
  25. 25. Pancytopenia +markedly Hypocellular scattered mature lymphocytes aplastic anemia
  26. 26. Pancytopenia + Hypercellular BM Infiltration by RS cells HL
  27. 27. Pancytopenia + Hypercellular B.M + old age MDS
  28. 28. Pancytopenia + Hypercellular marrow Infiltration with malignant cells (Metastasis)
  29. 29. Specific investigations  Megaloblastic anemia: Vit.B12 , Folate assay  Multiple myeloma : Imunoelectrophoresis  PNH: Flow cytometry (CD55, CD59)  Leishmaniasis: blood and bone marrow culture, serum ELISA  HIV ,EBV , hepatitis : virology screen  Fanconi anemia : Chromosomal breakage study

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