Aplastic anemia: Difference between revisions
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==Background== | ==Background== | ||
*Absence or decreased number of hematopoietic precursor cells | *Absence or decreased number of hematopoietic precursor cells → [[pancytopenia]] ([[anemia]], [[thrombocytopenia]], neutropenia) | ||
*Causes: | *Causes: | ||
**Drug-induced ([[chloramphenicol]], [[carbamazepine]], [[valproic acid]], [[phenytoin]]) | **Drug-induced ([[chloramphenicol]], [[carbamazepine]], [[valproic acid]], [[phenytoin]]) | ||
**Viral infection ([[parvovirus B19]], [[HIV]], hepatitis), especially in patients with sickle cell disease or immunocompromise | **Viral infection ([[parvovirus B19]], [[HIV]], [[viral hepatitis|hepatitis]]), especially in patients with [[sickle cell disease]] or immunocompromise | ||
**Autoimmune | **Autoimmune | ||
**Congenital (Fanconi anemia) | **Congenital (Fanconi anemia) | ||
==Clinical Features== | ==Clinical Features== | ||
*Anemia | *[[Anemia]] | ||
**Weakness, fatigue, dyspnea | **[[Weakness]], [[fatigue]], [[dyspnea]] | ||
*Thrombocytopenia | *[[Thrombocytopenia]] | ||
**Mucosal bleeding, petechiae | **Mucosal bleeding, [[petechiae]] | ||
*Neutropenia | *[[Neutropenia]] | ||
**Recurrent infections, fever | **Recurrent [[neutropenic fever|infections]], [[fever]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Differential Diagnosis== | |||
===Pancytopenia Causes=== | |||
*[[Acute leukemia]] | |||
*[[Myelodysplastic syndrome]], [[myelofibrosis]] | |||
*[[Aplastic anemia]] | |||
*Infiltrative disease (e.g. [[lymphoma]], [[multiple myeloma]], metastatic carcinoma) | |||
*[[Paroxysmal nocturnal hemoglobinuria]] | |||
*Drugs/treatments (*drugs more commonly associated with pancytopenia) | |||
**Bone marrow irradiation* | |||
**Chemotherapy*(especially anthracyclines, [[methotrexate]]) | |||
**Anti-inflammatories ([[rituximab]]*, sulfasalazine*, [[colchicine]], [[azathioprine]], [[methotrexate]]) | |||
**Antimicrobials ([[chloramphenicol]], [[ganciclovir]], [[penicillin G]]*, [[dapsone]]*, [[quinine]] | |||
**Thiomides ([[propylthiouracil]]*, [[methimazole]]*, carbimazole) | |||
**[[Antipsychotics]] ([[clozapine]]*, [[olanzapine]] | |||
**[[Procainamide]]* | |||
**[[Cyclophosphamide]] | |||
**[[Antiepileptics]] ([[phenytoin], [[carbamazepine]], [[phenobarbital]]) | |||
*Infection | |||
**[[Tuberculosis]] | |||
**[[AIDS]] | |||
**[[Leishmaniasis]], [[brucellosis]], [[histoplasmosis]]. | |||
**Viruses causing [[aplastic anemia]] ([[viral hepatitis]], [[Epstein-Barr virus]], [[HIV]], [[parvovirus B19]]) | |||
*[[Systemic lupus erythematosus]] | |||
*Hypersplenism | |||
*[[Acute radiation syndrome]] | |||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
*Transfuse PRBCs/platelets as needed for severe anemia/thrombocytopenia | *Transfuse [[PRBCs]]/[[platelets]] as needed for severe anemia/thrombocytopenia | ||
*Antimicrobials if febrile and neutropenic | *[[antibiotics|Antimicrobials]] if febrile and neutropenic | ||
==Disposition== | ==Disposition== | ||
*Generally admit | |||
==See Also== | ==See Also== | ||
Latest revision as of 23:38, 30 September 2019
Background
- Absence or decreased number of hematopoietic precursor cells → pancytopenia (anemia, thrombocytopenia, neutropenia)
- Causes:
- Drug-induced (chloramphenicol, carbamazepine, valproic acid, phenytoin)
- Viral infection (parvovirus B19, HIV, hepatitis), especially in patients with sickle cell disease or immunocompromise
- Autoimmune
- Congenital (Fanconi anemia)
Clinical Features
- Anemia
- Thrombocytopenia
- Mucosal bleeding, petechiae
- Neutropenia
- Recurrent infections, fever
Differential Diagnosis
Differential Diagnosis
Pancytopenia Causes
- Acute leukemia
- Myelodysplastic syndrome, myelofibrosis
- Aplastic anemia
- Infiltrative disease (e.g. lymphoma, multiple myeloma, metastatic carcinoma)
- Paroxysmal nocturnal hemoglobinuria
- Drugs/treatments (*drugs more commonly associated with pancytopenia)
- Bone marrow irradiation*
- Chemotherapy*(especially anthracyclines, methotrexate)
- Anti-inflammatories (rituximab*, sulfasalazine*, colchicine, azathioprine, methotrexate)
- Antimicrobials (chloramphenicol, ganciclovir, penicillin G*, dapsone*, quinine
- Thiomides (propylthiouracil*, methimazole*, carbimazole)
- Antipsychotics (clozapine*, olanzapine
- Procainamide*
- Cyclophosphamide
- Antiepileptics ([[phenytoin], carbamazepine, phenobarbital)
- Infection
- Tuberculosis
- AIDS
- Leishmaniasis, brucellosis, histoplasmosis.
- Viruses causing aplastic anemia (viral hepatitis, Epstein-Barr virus, HIV, parvovirus B19)
- Systemic lupus erythematosus
- Hypersplenism
- Acute radiation syndrome
Evaluation
- CBC: pancytopenia
- Reticulocyte count: reduced or absent
- Peripheral smear
Management
- Transfuse PRBCs/platelets as needed for severe anemia/thrombocytopenia
- Antimicrobials if febrile and neutropenic
Disposition
- Generally admit