Pancytopenia and Bone Marrow Failure

Question 1

What is pancytopenia?

Answer 1

A reduction in all major cell lines, red cells, white cells and platelets.

Question 2

There is a deficiency in the following 3 major blood components:

• RBCs
• WBCs
• Platelets

What medical words are used to describe these?

Answer 2

Anaemia

Leukopenia

Thrombocytopenia

Question 3

Causes of bone marrow failure:

What type of anaemia will reduce marrow production?
What sort of infiltrative diseases will do the same?
Why does megaloblastic anaemia cause it?

Causes of pancytopenia outside bone marrow failure:
- What will increase peripheral destruction?

Answer 3

Bone marrow failure due to aplastic anaemia

Acute leukaemia
Myeloma
Lymphoma
Could also be mets

Megaloblastic anemia is characterized by red blood cells that are larger than normal. There also aren’t enough of them. It’s known as vitamin B-12 or folate deficiency anemia, or macrocytic anemia, as well. Megaloblastic anemia is caused when red blood cells aren’t produced properly.

Hypersplenism

Question 4

Symptoms:

Anaemia symptoms - 5

Neutropenia (agranulocytosis):

• What does this put the patient at risk of?
• How does it usually present?

Thrombocytopenia symptoms - 3

Answer 4

Pallor 
SOB
Fatigue 
Angina
Tachycardia 

Immunosuppression

Sore throat - they should report any fever

Bruising
GI/intracranial bleeding

Question 5

Investigations - Identifying pancytopenia:

FBC - what do you look at? - 3

What will a blood film show?

What will be lowered which are precursors of RBC’s?

Answer 5

Hb
WBC
Platelets

Immature RBCs and WBCs

Reticulocytes

Question 6

Investigations - Identifying cause:

What vitamins should be tested for?

Why is viral serology done?

Answer 6

B12 and folate

Because viruses can trigger aplastic anaemia
e.g. Parvovirus B19, EBV, CMV, HIV

Question 7

Investigations - Bone marrow sampling:

Where is it usually done?

Trephine biopsy is done. What is trephine?

Answer 7

Posterior iliac crests

The core of the bone which allows assessment of bone marrow cellularity, architecture, and the presence of infiltrative disease

Question 8

Management - Marrow support:

How long do RBCs survive compared to WBC and platelets which is the reason why early problems are mainly from neutropenia and thrombocytopenia?

What type of transfusions can be given? - 2

What type of transplant may be needed?

Answer 8

120 days - RBC

1-2 days - WBC

8 days - platelets

RBC and platelets - as RBC on its own will cause a further drop in platelets

Haematopoietic stem cell transplantation may be needed