AM Report Pearls: Approach to Pancytopenia

I like Harry’s pathology-based approach, so I consulted the American Journal of Clinical Pathology for this approach http://ajcp.ascpjournals.org/content/139/1/9.full – enjoy!

  1. Aplastic bone marrow:
    1. Idiopathic aplastic anemia
    2. Aplastic anemia due to drugs & chemicals (including chloramphenicol, benzene & other industrial solvents, insecticides)
    3. Viruses – classically parvovirus B19, but can be seen with other viruses
    4. PNH (Paroxysmal Nocturnal Hemoglobinuria)
  2. Marrow-space Infiltrative bone marrow:
    1. Leukemias and lymphomas, MDS esp myelofibrosis
    2. Infections, especially granulomatous diseases such as TB, MAC, and histoplasmosis
  3. Autoimmune diseases, especially SLE
  4. Sequestration from Splenomegaly
  5. Nutritional deficiencies – copper deficiency, B12/folate deficiencies, severe anorexia nervosa
  6. RARE but think about in kids/young adults – Congenital bone marrow failure syndromes – Fanconia anemia being the most common one
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