Pancytopenia Evaluation in Hematology

Pancytopenia is defined by simultaneous reduction of red cells, white cells, and platelets and arises from peripheral destruction or sequestration, marrow infiltration, or marrow failure. The differential includes aplastic anemia, myelodysplastic syndromes, acute leukemia, lymphoma, megaloblastic anemia, hypersplenism, and severe sepsis.

Stepwise evaluation begins with thorough history and examination for hepatosplenomegaly, lymphadenopathy, infections, drug exposures, and toxin contact. Peripheral smear and reticulocyte count direct subsequent testing toward hemolysis, hypoproliferation, or dysplasia.

Bone marrow aspiration and biopsy are central to characterize cellularity, dysplasia, infiltration, and fibrosis. Cytogenetics, flow cytometry, viral testing for parvovirus B nineteen and human immunodeficiency virus, and nutritional studies guide specific therapy ranging from immunosuppression to chemotherapy or transplant.