Pancytopenia Flashcards
define pancytopenia
a deficiency of blood cells of all lineages
what lineage tends to not be included in pancytopenia
lymphocytes
pancytopenia indicates bone marrow failure T or F
F, not always
what lineages are low in pancytopenia
erythrocytes
platelets
granulocytes
fundamental causes of pancytopenia?
reduced production
increased destruction
bone marrow failure is more commonly acquired or inherited
acquired
triad of characteristics in inherited bone marrow failure?
cancer predisposition
impaired haemopoeisis
congenital abnormalities
give an example of an inherited bone marrow failure
fanconi’s anaemia
what bone is malformed or completely lost in fanconi’s anaemia?
radial
what cells tend to be lost first in fanconi’s anaemia
macrocytosis first
thrombocytopenia next
neutropenia next
risk of leukaemia in fanconis?
1 in 2
acquired causes of primary bone marrow failure?
myelodysplastic syndromes
acute leukaemia
idiopathic aplastic anaemia
what happens in IAA
autoimmune attack by T cells against haemopoeitic STEM cells
what does the marrow look like in aplastic anaemia?
fatty, lacking erythrocytes
what does the marrow look like in MDS?
hypercellular
full of dysplastic cells
why is the cell count low in MDS if the marrow is hypercellular?
its ineddective erythopoesis as there is increased apoptosis and dysplasia
MDS can become what cancer..
AML
dysplastic cells in the bone marrow…
MDS
why can acute leukaemia cause pancytopenia?
abnormal blasts proliferate from leukaemic stem cells so are unable to differentiate
secondary causes of bone marrow failure?
drugs eg chemo/alcohol cause aplasia B12/folate deficiency lymohoma/mets HIV storage disease
B12/folate deficiency causes a ___cellular marrow
hypercellular
inc division in primitive cells
drug induced BM failure causes a __cellular marrow
hypo
why is it important that cells transitting through the spleen do so quickly?
macrophages within the cords of the spleen will destroy blood cells if theyre slow
you have a/an ___ed splenic pool in hypersplenism
increased
red cell transit is fast/slow in hypersplenism
slow
what haemotological cancer can cause hypersplenism?
splenic lymphoma
triad of issues in pancytopenia
anaemia
neutropenia
thrombocytopenia
symptoms of anaemia
fatigue
SoB
cardiovascular comprise
symptoms of neutropenia
infection esp gram -ve
symptoms of thrombocytopenia
purpura
petechiae
bleeds
Ix pancytopenia
- and film
- based on findings:
B12/folate
LFTs
virology
autoantibody
cytogenics
chromosomal
macrovalocytes + hypersegmented neutrophils…
B12/folate deficiency
Tx pancytopenia
treat cause
replace losses eg transfusion/antibiotics
neutropenic fever should get antibiotics straight away without waiting for microbio results T or F
T
Tx malignancy that is causing a primary BM disorder
chemo
Tx congenital problem that is causing a primary BM disorder
bone marrow transplant
Tx IAA
immunosuppression
Tx hypersplenism
treat cause if possible
consider splenectomy
