Pancytopenia

Aka: Pancytopenia, Bicytopenia

1. See Also
   1. Aplastic Anemia
2. Definition
   1. Bicytopenia: decrease in two of three cell lines
      1. May suggest Pancytopenia in development
   2. Pancytopenia: decrease in all blood cell lines
      1. Anemia
      2. Leukocytopenia
      3. Thrombocytopenia
3. Causes
   1. Aplastic Anemia
   2. Vitamin B12 Deficiency
   3. Folate Deficiency
   4. Systemic Lupus Erythematosus
   5. Paroxysmal Nocturnal Hemoglobinuria
   6. Severe infection
   7. Brucellosis
   8. Sarcoidosis
   9. Pregnancy
   10. Fanconi's Anemia
   11. Primary Bone Marrow disorder
       1. Multiple Myeloma
       2. Metastatic cancer
       3. Myelofibrosis
       4. Osteopetrosis
   12. Splenic disorder
       1. Lymphoma
       2. Gaucher Disease
       3. Niemann-Pick Disease
       4. Splenomegaly due to congestion
       5. Kala-Azar
4. Signs: Clinical Clues
   1. Splenomegaly
   2. Lymphadenopathy
5. Labs
   1. Complete Blood Count
      1. Pancytopenia consistent with cell counts as below
   2. Peripheral Smear
      1. Macrocytic Anemia
      2. Reticulocytopenia (Reticulocyte Index <1%)
      3. Thrombocytopenia (Platelet Count <20,000/mm3)
      4. Neutropenia
         1. Absolute Neutrophil Count <500/mm3
         2. ANC <200/mm3 suggests very severe disease
6. Evaluation
   1. Bone Marrow Biopsy: Normal count or hyperplasia
      1. Findings: Blasts, Dysplasia or Fibrosis
      2. Examples (See causes above)
         1. Myelodysplastic Syndrome
         2. Acute Myeloid Leukemia (AML)
         3. Agnogenic myeloid metaplasia
   2. Bone Marrow Biopsy: Fat infiltration (Hypoplasia)
      1. Acquired Aplastic Anemia or
      2. Fanconi's Anemia
         1. Diepoxybutane induced chromosome breakage or
         2. Mitomycin-C induced chromosome breakage
7. References
   1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 1449
   2. Saiki in Friedman (1991) Medical Diagnosis, p. 225