Approach to the Cytopaenic Patient Flashcards
What are the causes of impaired blood cell production?
acquired aplastic anaemia
congenital aplastic anaemia
bone marrow infiltrative disorders
myelodysplastic syndrome
What is the cause of acquired aplastic anaemia?
autoimmune destruction of pluripotent haematopoietic stem cells by T lymphocytes
What are the findings of a bone marrow biopsy in asquired aplastic anaemia?
reduced cellularity
absence of fibrosis and malignant cells
What is the treatment for idiopathic acquired aplastic anaemia?
if less than 50 -> HSCT
if > 50 -> triple immunosuppressive therapy: anti thymocyte globulin, cyclosporin, methylprednisolone
What drugs can cause pancytopaenia?
benzene chemotherapy drugs NSAIDs anti epilpetics steroids chloramphenicol
Why should patients be tested for dihydropyrimidine dehhydrogenase deficiency prior to starting fluropyrimidines?
increased risk of severe/fatal pancytopaenia
What is the mechanism in which alcohol causes pancytopaenia?
direct bone marrow toxicity
increased iron absorption -> iron overload and cirrhosis
interference with folate absorption
acetaldehyde forming adducts with cell membrane phospholipids -> damages red blood cells
When is the nadir of pancytopaenia with radiotherapy?
1-4 weeks
What are the common viral causes of pancytopaenia?
hepatitis A, B, C CMV EBV HHV6 HIV
What are the main solid tumours which can cause bone marrow infiltrative disorders?
prostate, breast, lung
What are causes of peripheral destruction leading to pancytopaenia?
autoimmune mediated
splenic sequestration
What mutation causes paroxysmal nocturnal haemoglobinuria?
mutation in PIGA gene
