PANCYTOPENIA

23 Feb, 2021

Dr. Rajesh Bollam

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⬇️ PANCYTOPENIA 🧪🩸 : Approach in Emergency Room


The mechanistic framework of "production, destruction, sequestration" can be challenging since some syndromes can cause pancytopenia by > 1 mechanism.
On a busy call night, first ask:
🚨 Is this an emergency?🚨
Look for
🔍Dangerous Etiologies
🔍Dangerous Consequences
Dangerous Etiologies:
🔵TTP
(Schistocytes? Plt<30? CNS changes?)
🔵Acute Leukemia
(Blasts on smear? DIC? TLS?)
🔵HLH
(check ferritin, trig if 📈 suspicion)
☎️ These are reasons to call #hematologist overnight!
Dangerous consequences of low cell counts:
⚪ Febrile Neutropenia
🔴 Symptomatic anemia
🔹️Possible bleeding with severe thrombocytopenia
After checking for emergencies you look at 5 main buckets in your ddx:
🟣 Drugs
Run the med list!
🔴Infections
SO MANY. Common ones to remember & test for: HIV, EBV, viral hepatitis, subacute bacterial endocarditis
🟢 Nutrition
🔵 Autoimmune
🟡 Organs & BM

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