Tutorial :5
باطنيةد. عبدالحق
عدد الاوراق (2)
28/8/2012PANCYTOPENIA
Pancytopenia is the pronounced reduction in the number of erythrocytes, all types of HYPER13HYPERLINK "http://www.wikidoc.org/index.php/White_blood_cell"white blood cells and blood HYPERLINK "http://www.wikidoc.org/index.php/Platelets"platelets that are circulating in the bloodPancytopenia (BM?) can be due to * decrease in hemaopoietic cell production in the bone marrow e.g. by infections, toxins,radiation, malignant cell infiltration or suppression or can have * normocellular or even hypercellular marrow, without any abnormal cells, e.g. ineffective hematopoiesis (MEG. AN.)and dysplasia, * maturation arrest of all cell lines and peripheral sequestration of blood cells.
HYPERLINK "http://www.wikidoc.org/index.php/Aplastic_anemia" \o "Aplastic anemia"Causes 1.Megaloblastic Anemia 2.Aplastic anemia PNH 3.HYPERLINK "http://www.wikidoc.org/index.php/Leukemia" \o "Leukemia"Acute Leukemia 4.HYPERLINK "http://www.wikidoc.org/index.php/Lymphoproliferative_Disorders" \o "Lymphoproliferative Disorders"Lymphoproliferative Disorders 5.HYPERLINK "http://www.wikidoc.org/index.php/Myelodysplastic_syndrome" \o "Myelodysplastic syndrome"Myelodysplastic syndrome 6.HYPERLINK "http://www.wikidoc.org/index.php/Bone_marrow" \o "Bone marrow"Bone marrow replaced by HYPERLINK "http://www.wikidoc.org/index.php/Tumor" \o "Tumor"tumor(myelophthesis) 7.HYPERLINK "http://www.wikidoc.org/index.php/Myelofibrosis" \o "Myelofibrosis"Myelofibrosis(advanced) 8.overwhelming Infections: Sepsis, Hemorrhagic fevers,viral infections (AIDS.. most common) Leishmaniasis(child) Disseminated Tuberculosis
9.Cirrhosis(Hypersplenism) 10.HYPERLINK "http://www.wikidoc.org/index.php/Drug" \o "Drug"Drugs/HYPERLINK "http://www.wikidoc.org/index.php/Toxins" \o "Toxins"Toxins & irradiation(causing BM suppression) 10.OthersHYPERLINK "http://www.wikidoc.org/index.php/Felty's_Syndrome" \o "Felty's Syndrome"Felty's Syndrome SLE & immune pancytopenia HYPERLINK "http://www.wikidoc.org/index.php/Graft-versus-host_disease" \o "Graft-versus-host disease"Graft-versus-host disease HYPERLINK "http://www.wikidoc.org/index.php/Osteoporosis" \o "Osteoporosis"Osteoporosis HYPERLINK "http://www.wikidoc.org/index.php/Sarcoidosis" \o "Sarcoidosis"SarcoidosisHYPERLINK "http://www.wikidoc.org/index.php/Thymoma" \o "Thymoma" ,Thymoma
CLINICAL FEATURES should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever and tendency to bleed
INVESTIGATIONS CBC :Morphology of the blood smear..eg: Oval macrocytes ,Hyperseg of Neutrophils ,blasts? Tear drop?
PANCYTOPENIA →UNEXPLAINED ? →BM ASPIRATION →ABNORMAL?IF NORMAL→MEAN PERIPHERAL DESTRUCTION
100 patients w Pancytopenia were studied by pakistani team of physicians in 2001 the final diagnosis was as follow:1.Megaloblastic Anemia27 (27%)with Hemolytic Anemia7 (7%) with Sepsis5 (5%) Total 39 patients (39%) 2.Hypersplenism With Cirrhosis12 (12%) With Chronic Malaria3 (3%) Undiagnosed4 (4%) Total19 (19%) 3.Aplastic Anemia8 (8%) 4.Myelodysplasia5 (5%)
5.Septicemia and DIC (5%) 6.Iron Deficiency Anemia with Leucopenia(5%) 7.Connective Tissue Disease (SLE) (3%) 8.Disseminated Tuberculos2 (3%) 9.AIDS and Septicemia (1%) 10.Disseminated Malignancy (2%) 11.Hypoplastic Marrow(2%) 12.Viral Hemorrhagic Fever (CCHF) (1%) 13.Acute Lymphocytic Leukemia- (1%) 14.Mixed Leukemia- (1%) 15.Undiagnosed (5%) Total100
74 male presents with neuropathy, loss of balance, WBC 1.9, HGB 7, PLT 120,000
A 20 YO woman presents with increasing weakness over six weeks,fever and Hb = 5.9 g/dl., white cells 18.0 x109/l., platelets 35 x109/l.