Pancytopenia

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Pancytopenia is a medical condition characterised by the reduction of all three cellular components of the blood: red blood cells, white blood cells, and platelets. This results in anaemia, leukopenia, and thrombocytopenia, respectively.

Aetiology

Pancytopenia can result from a variety of underlying causes, including:

• Bone marrow failure (e.g., aplastic anaemia)
• Bone marrow infiltration (e.g., leukaemia, myelodysplastic syndromes)
• Infections (e.g., viral infections like HIV, hepatitis)
• Medications and toxins (e.g., chemotherapy, radiation therapy, benzene)
• Autoimmune disorders (e.g., systemic lupus erythematosus)
• Genetic disorders (e.g., Fanconi anaemia)
• Chronic liver disease

Pathophysiology

The pathophysiology of pancytopenia varies depending on the underlying cause:

• Bone marrow failure: Due to direct damage to the hematopoietic stem cells.
• Bone marrow infiltration: Replacement of normal marrow tissue with abnormal cells.
• Peripheral destruction: Increased destruction of blood cells due to autoimmune processes or hypersplenism.

Risk Factors

• Exposure to certain medications or toxins
• Family history of haematological disorders
• Chronic infections
• Autoimmune diseases
• Previous history of cancer or radiation therapy
• Chronic liver disease

Signs and Symptoms

Common signs and symptoms of pancytopenia include:

• Fatigue and weakness (due to anaemia)
• Frequent infections (due to leukopenia)
• Easy bruising and bleeding (due to thrombocytopenia)
• Pallor
• Shortness of breath
• Dizziness
• Petechiae and purpura

Investigations

• Full blood count (FBC) with differential
• Peripheral blood smear
• Bone marrow biopsy and aspiration
• Serum vitamin B12 and folate levels
• Liver function tests
• Renal function tests
• Viral serologies (e.g., HIV, hepatitis)
• Autoimmune screening (e.g., ANA, anti-dsDNA)

Management

Primary Care Management

• Immediate referral to a haematologist: For further evaluation and management
• Supportive care:
  • Transfusions (red blood cells, platelets) as needed
  • Infection prevention (e.g., prophylactic antibiotics, vaccinations)
• Monitoring: Regular follow-up with FBC and clinical assessment

Specialist Management

• Treatment of underlying cause: Addressing the primary condition (e.g., chemotherapy for leukaemia, immunosuppressive therapy for autoimmune conditions)
• Bone marrow transplant: For conditions like aplastic anaemia or severe myelodysplastic syndromes
• Growth factor therapy: Erythropoietin, G-CSF to stimulate bone marrow production
• Regular follow-up to monitor response to treatment and manage any complications

References

1. Patient.info. (2024). Pancytopenia. Retrieved from Patient.info
2. NHS. (2023). Pancytopenia. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Pancytopenia: Diagnosis and Management. Retrieved from BMJ
4. American Society of Hematology (ASH). (2021). Clinical Practice Guidelines: Pancytopenia. Retrieved from ASH

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