This document discusses pancytopenia, aplastic anemia, and sideroblastic anemia. It provides details on: - Causes of pancytopenia including aplastic anemia, leukemia, myelodysplastic disorders, and bone marrow infiltration. - Investigations for pancytopenia including blood tests, bone marrow examination, and other tests. Specific findings on blood film and bone marrow aspiration are outlined. - Aplastic anemia is defined as reduction in all blood cell lines from bone marrow aplasia. It can be idiopathic, congenital, or secondary to drugs, radiation, chemicals, or infections. Clinical features and blood/bone marrow findings in a

1. Pancytopenia , Aplastic anaemia
and Sideroblastic anemia
Dr. Mehdi Ashik Chowdhury
M.B.B.S. MD. (BSMMU)
Assistant Professor &
Head of the Department of Pathology
Tairunnessa Memorial Medical College

2. • Pancytopenia refers to reduction in the count of all blood
cell lines producing anaemia, leucopenia and
thrombocytopenia.
• Causes of Pancytopenia :
• Aplastic anaemia.
• Subleukaemic acute leukaemia
• Myelodysplastic disorder.
• Myelofibrosis.
• Bone marrow infiltration or replacement by :
Lymphoma, Multiple myeloma, Metastatic carcinoma.
• Hypersplenism.
• Systemic lupus erythematosus (SLE)
• Megaloblastic anaemia.

3. • Investigation of a case of pancytopenia :
• Clinical feature
• Blood examination
• Bone marrow examination
• Biochemical investigation
• Sometimes more extensive test such as :
• X-ray, CT scan, MRI, Immunological test.
• Blood film :
Anisocytosis and poikilicytosis : Common in
metastatic bone carcinoma, Acute leukaemia. Less
marked in aplastic anaemia. Tear drop poikilocytes
are notably present in myelofibrosis.

4. • Leukoerythroblastic blood picture :
Metastatic carcinoma
Myelofibrosis
Subleukaemic acute leukaemia.
Plasmacytic cell or plasmablast : Multiple myeloma.
Leukoerythroblastic blood picture and plasmacytic
cells are absent in aplastic anaemia.
Toxic granulation occasionally occurs in aplastic
anaemia independently of infection.
Hypogranular neutrophil and pelger-Huet bilobed
nuclear configuration is seen in myelodysplastic
disorder. Hypersegmentation of neutrophil is present
in Megaloblastic anaemia.

5. • Blood film show marked rouleaux formation in
multiple myeloma. Very high ESR is seen in multiple
myeloma and Aplastic anaemia.
• Bone marrow aspiration : A dry or blood tap may be
present in Aplastic anaemia. Myelofibrosis almost
always show dry tap. Trephine biopsy is needed in
these condition.
• Marrow aspiration is diagnostic in :
Subleukaemic leukaemia.
Multiple myeloma
Aplastic anaemia.
In disseminated tuberculosis AFB can be demonstrated
by Ziehl-Neelsen stain.

6. Aplastic Anaemia
• Aplastic anaemia may be defined as reduction in the
count of all blood cell lines producing anaemia,
leucopenia and thrombocytopenia resulting from
aplasia of bone marrow.
• Aplastic anaemia may be classified as :
• 1) Idiopathic- When no cause is evident.
• 2) Secondary- When the disorder is the result of
exposure to certain drugs, chemicals or viral agent.
• 3) Congenital.

7. • Aetiology :
• Idiopathic
• Congenital
• Secondary to :
Exposure of Ionizing radiation
Chemicals- Benzene, Insectisides, DDT.
Drugs : Those that regularly cause marrow depression,
Busulphan, Cyclophosphamide.
Those that occasionally or rarely cause marrow
depression (e.g. Chloramphenicol, Sulphonamides,
gold).
Infection : Viral hepatitis.

8. • Bone marrow failure implies peripheral blood
cyotopenia arises primarily as a result of specific
failure of bone marrow precursor cells to produce
mature cells, rather than the production of abnormal
cells which have a shortened survival or the
production of normal cells which are subjected to an
abnormal environment. In bone marrow failure the
remaining cells appear normal or near normal,
reflecting only minor changes produced by “marrow
stress”, including a mild increase in dyserythropoietic
form, often with some macrocytosis of red cells. The
stroma of the marrow does not appear to be disturbed.
These observations distinguish bone marrow failure
from myelodysplastic and myeloproliferative
syndrome.

9. • Clinical feature :
• Sign symptoms of anaemia.
• Bleeding manifestation due to thrombocytopenia,
such as ecchymoses, epistaxis, menorrhagia, gum
bleeding.
• Infection result from neutropenia such as sore throat,
fever, Skin infection etc.

10. Blood Picture :
Hb : Reduced.
MCV : May be normal or high.
MCH and MCHC are normal.
ESR : Markedly increased.
• RBC : Normocytic and normochromic. Mild to
moderate degree of macrocytosis is common.
• WBC : Total count is reduced . There is usually
relative lymphocytosis.
• Platelets are reduced.
• Reticulocyte count usually reduced.

11. • Bone marrow
• Hypocellular marrow with replacement of marrow (More
than 75%) by fat cells.
• (Normal : 50% cell and 50% fat cells, Hypercellular : less
than 25% of marrow is fat cells, Hypocellular : More
than 75% fat cells)
• Myeloid erythroid ratio : Normal or reduced.
• Erythropoiesis : Depressed but normoblastic.
• Granulopoiesis : Depressed but maturing to segmented
form.
• Megakaryocytes : Reduced.
• Lymphocytes and plasma cells are easily seen (Most of
cells of bone marrow).
• There may be dry tap or blood tap. Trephine biopsy is
needed when there is dry tap or blood tap. Usually in
aplastic anaemia there is no blood tap or dry tap as
marrow is replaced by fat cells which are easily aspirated.

12. Sideroblastic Anemia