Pancytopenia

Background

• Anemia + Thrombocytopenia + Leukopenia

Clinical Features

• Low hemoglobin/hematocrit, platelets, and white blood cell count
• Signs/symptoms of anemia (e.g. fatigue, dyspnea, tachycardia, pallor)
• Signs/symptoms of thrombocytopenia (e.g. petechiae/purpura, mucosal bleeding, GI bleed, hematuria, intracranial hemorrhage)
• Signs/symptoms of leukopenia (e.g. recurrent, severe, or opportunistic infection)

Causes

• Acute leukemia
• Myelodysplastic syndrome, myelofibrosis
• Aplastic anemia
• Infiltrative disease (e.g. lymphoma, multiple myeloma, metastatic carcinoma)
• Paroxysmal nocturnal hemoglobinuria
• Drugs/treatments (* indicates drugs more commonly associated with pancytopenia)
  • Bone marrow irradiation*
  • Chemotherapy* (especially anthracyclines, methotrexate)
  • Cyclophosphamide
  • Anti-inflammatories (rituximab*, sulfasalazine*, colchicine, azathioprine, methotrexate)
  • Antimicrobials (chloramphenicol, gancyclovir, penicillin G*, dapsone*, quinine
  • Thiomides (propythiouricil*, methimazole*, carbimazole)
  • Antiepileptics ([[phenytoin], carbemazepime, phenobarbital)
  • Antipsychotics (clozapine*, olanzapine
  • Procainamide*
• Infection
  • Tuberculosis
  • AIDS
  • Leishmaniasis, brucellosis, histoplasmosis.
  • Viruses causing aplastic anemia (hepatitis, Epstein-Barr virus, HIV, parvovirus B19)
• Systemic lupus erythematosus
• Hypersplenism
• Acute radiation syndrome

Evaluation

• Evaluate for causes of pancytopenia
  • Drug history, infectious work-up, smear, malignancy work-up
• Evaluate for dangerous sequalae
  • See evaluation of anemia, thrombocytopenia, neutropenia

Management

• See management of anemia, thrombocytopenia, neutropenia
• Consider appropriate consults (e.g. heme/onc, infectious disease)

See Also

• Anemia
• Thrombocytopenia
• Neutropenia, Leukopenia
• Immunocompromised infections
• Aplastic anemia