Investigations of pancytopenia
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This document provides an overview of pancytopenia, including its definition, etiology, clinical presentation, diagnostic workup, and treatment approach. Pancytopenia is defined as a low hemoglobin, white blood cell count, and platelet count. It can be caused by primary bone marrow diseases or secondary to other conditions that impair bone marrow function. The diagnostic workup involves blood tests, peripheral smear examination, bone marrow aspiration and biopsy for cytogenetics and immunophenotyping to identify the underlying cause. Specific tests help diagnose conditions like Fanconi anemia, lymphoproloferative disorders, and paroxysmal nocturnal hemoglobinuria. Treatment is directed at managing the specific disease identified as the cause
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Approach to pancytopenia .Dr ABHIJEET BARUA MD PGT.KOL.MED.CLG.
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Pancytopenia is a reduction in red blood cells, white blood cells, and platelets caused by decreased bone marrow production or destruction of blood cells. Evaluation of pancytopenia involves examining the complete blood count, peripheral smear, and bone marrow aspiration and biopsy to determine if the cause is aplasia, deficiencies, infections, infiltrative disorders, or primary bone marrow diseases like myelodysplastic syndrome. Management depends on the underlying etiology based on history, examination, and specific diagnostic tests.Pancytopenia Approach
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Pancytopenia is a reduction in red blood cells, white blood cells, and platelets. The document outlines an approach to evaluating a case of pancytopenia, including considering decreased bone marrow production, increased cell destruction, a thorough history and physical exam, and diagnostic tests like complete blood count, peripheral smear, and bone marrow aspiration and biopsy to determine the underlying cause. The causes of pancytopenia are grouped based on mechanism and include conditions like aplastic anemia, megaloblastic anemia, myelodysplastic syndrome, liver disease, and others.Laboratory investigations in pancytopenia
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This document discusses investigations for pancytopenia. It defines pancytopenia as a low count of red blood cells, white blood cells, and platelets. The causes of pancytopenia include inherited disorders, primary bone marrow disorders, and systemic disorders that affect the bone marrow. Key investigations discussed are peripheral blood smear, bone marrow aspiration and biopsy, and additional tests depending on the suspected cause. Specific cases are presented to demonstrate how the history, physical exam, and test results can help arrive at a diagnosis for an individual patient.Aplastic anemia
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This document discusses aplastic anemia, which is a failure of the bone marrow to produce sufficient new blood cells, leading to pancytopenia (low red blood cells, white blood cells, and platelets). It may be idiopathic or secondary to drugs, radiation, infections, or immune diseases. Symptoms include anemia, infections, and bleeding. Diagnosis involves a bone marrow biopsy showing hypoplastic marrow. Treatment options include supportive care with transfusions, immunosuppressive drugs like antithymocyte globulin, bone marrow transplantation, and growth factors.Pancytopenia
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Pancytopenia is a medical condition characterized by the reduction of red blood cells, platelets, and white blood cells, which can derive from decreased bone marrow function or increased peripheral destruction. Common causes include aplastic anemia, infections, and nutritional deficiencies, and diagnosis involves clinical history, blood tests, and bone marrow examinations. Treatment focuses on addressing the underlying causes of anemia, thrombocytopenia, and leucopenia.Pancytopenia
Pancytopeniabasiohack
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1. Pancytopenia is defined as a reduction in red blood cells, white blood cells, and platelets below the normal range.
2. The most common causes of pancytopenia include megaloblastic anemia, infections, hypersplenism, aplastic anemia, drug-induced pancytopenia, and acute myeloid leukemia.
3. Evaluation of pancytopenia involves a complete blood count, peripheral smear, bone marrow aspiration and biopsy to determine if the bone marrow is aplastic, infiltrated, or displaying dysplastic changes which can help identify the underlying cause.Aplastic anemia
Aplastic anemiareyhanakashaf
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Aplastic anemia is a condition characterized by bone marrow failure leading to pancytopenia and is more common in Asia than in the West, with a peak incidence in childhood and young adulthood. The etiology includes acquired and genetic factors, with the former being predominant, and clinical manifestations often involve anemia, thrombocytopenia, and neutropenia. Management includes supportive care, immunosuppressive therapy, and potential stem cell transplantation, with the prognosis improving significantly over time with advancements in treatment.Approach to pancytopenia.pptx
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1. A 12-year-old girl presented with fever, lethargy, gum bleeding, and epistaxis. On examination, she had pallor, petechiae, hepatomegaly, and hyperpigmented knuckles.
2. Laboratory findings showed pancytopenia, macroovalocytes on peripheral smear, and low serum B12 and folate levels. Bone marrow aspiration showed megaloblastic erythroid precursors and giant myelocytes/metamyelocytes.
3. Based on the findings, she was diagnosed with megaloblastic anemia secondary to vitamin B12 and folate deficiency. Treatment involves vitamin B12 and folate supplementation.APPROACH TO PANCYTOPENIA
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The document provides a comprehensive overview of pancytopenia, including its definition, causes (both inherited and acquired), and diagnostic approaches through history, examination, and lab evaluation. It details the differential diagnosis based on bone marrow cellularity and outlines further investigations necessary for assessment. The initial management and treatment options for pancytopenia, including supportive and specific treatments such as blood transfusions and stem cell transplantation, are also discussed.Approach to pancytopenia
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This document provides an overview of pancytopenia, including definitions, common causes, clinical evaluation, and diagnostic approach. Pancytopenia is defined as a reduction in all three blood cell lines. The evaluation involves obtaining a complete blood count with peripheral smear, bone marrow aspiration and biopsy, and specific tests depending on findings. The bone marrow examination can help differentiate causes based on cellularity and features seen in erythropoiesis, myelopoiesis, megakaryopoiesis and other cell types. Common causes include bone marrow failure, infiltrative disorders, infections, immune disorders and nutritional deficiencies. A thorough history, examination and systematic evaluation of the bone marrow are required to identify the underlying cause of pancyApproach to hemolytic anemia naglaa
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This document discusses an approach to diagnosing hemolytic anemia. The first step is to check the reticulocyte count to determine if the anemia is due to decreased red blood cell production or increased destruction. If the reticulocyte count is increased, a direct Coombs test is done. The peripheral blood smear is also examined to confirm or support the diagnosis. Based on Coombs test results, the cause of hemolysis can be intrinsic or extrinsic to the red blood cells. Additional tests are then used to determine the specific etiology or cause of hemolytic anemia.Pnh
PnhAnupam Singh
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Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematopoietic stem cell disorder characterized by hemolytic anemia, bone marrow failure, and thrombosis. It results from a somatic mutation in the PIG-A gene, leading to a deficiency in glycosylphosphatidylinositol-anchored proteins on the surface of blood cells. This renders the cells susceptible to complement-mediated lysis, causing intravascular hemolysis. Diagnosis involves flow cytometry to detect the deficient proteins on red blood cells and granulocytes. Management focuses on treating anemia, thrombosis, and infections, with complement inhibitors now providing an effective targeted treatment option. PNH has aPancytopenia among pediatric pateint
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The document provides a comprehensive overview of pancytopenia, including its definition, causes (both inherited and acquired), and diagnostic approaches through history, examination, and lab evaluation. It details the differential diagnosis based on bone marrow cellularity and outlines further investigations necessary for assessment. The initial management and treatment options for pancytopenia, including supportive and specific treatments such as blood transfusions and stem cell transplantation, are also discussed.Approach to pancytopenia
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油
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油
This document discusses an approach to diagnosing hemolytic anemia. The first step is to check the reticulocyte count to determine if the anemia is due to decreased red blood cell production or increased destruction. If the reticulocyte count is increased, a direct Coombs test is done. The peripheral blood smear is also examined to confirm or support the diagnosis. Based on Coombs test results, the cause of hemolysis can be intrinsic or extrinsic to the red blood cells. Additional tests are then used to determine the specific etiology or cause of hemolytic anemia.Pnh
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油
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematopoietic stem cell disorder characterized by hemolytic anemia, bone marrow failure, and thrombosis. It results from a somatic mutation in the PIG-A gene, leading to a deficiency in glycosylphosphatidylinositol-anchored proteins on the surface of blood cells. This renders the cells susceptible to complement-mediated lysis, causing intravascular hemolysis. Diagnosis involves flow cytometry to detect the deficient proteins on red blood cells and granulocytes. Management focuses on treating anemia, thrombosis, and infections, with complement inhibitors now providing an effective targeted treatment option. PNH has aPancytopenia among pediatric pateint
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油
Pancytopenia is a reduction in red blood cells, white blood cells, and platelets in the blood, resulting from various factors including bone marrow failure and immune-mediated destruction. Diagnosis involves clinical examination and specific tests like CBC and bone marrow biopsy, while treatments may include transfusions, corticosteroids, and bone marrow transplants. Congenital causes, such as Fanconi anemia, present with additional clinical features including skeletal and renal abnormalities.Haemolytic anemia
Haemolytic anemia Sri Devraj Urs medical college, Kolar, Karnataka , India
油
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油
This document provides an overview of approaches to diagnosing different types of anemia. It discusses how anemias can be classified based on red blood cell morphology or red cell kinetics. Common causes of anemia include deficiencies in iron, folate, vitamin B12, thalassemias, hemolytic anemias, bone marrow diseases, and anemia of chronic disease. Workup may involve blood smears, reticulocyte counts, iron studies, hemoglobin electrophoresis, and bone marrow examination. Distinguishing features of different anemias help identify underlying etiologies.Pancytopenia in pediatrcs
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This document provides an overview of myelodysplastic syndrome (MDS). It discusses the history and changing definitions of MDS, current WHO classification, clinical features, pathogenesis involving genetic and epigenetic abnormalities, dysplastic changes seen in the bone marrow, and identification of blast cells. MDS is a heterogenous stem cell disorder characterized by cytopenias, dysplasia, and increased risk of acute myeloid leukemia. The disease results from acquired mutations in hematopoietic stem/progenitor cells and involves dysregulated apoptosis, ineffective hematopoiesis, and genetic and epigenetic changes.Approach to microcytic hypochromic anemia
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油
This document discusses the approach to evaluating and diagnosing microcytic hypochromic anemia. It begins by covering the basics of hemoglobin synthesis and iron metabolism. It then describes the morphological classification of anemias and discusses the main causes of microcytic anemia including iron deficiency anemia, anemia of chronic disease, thalassemia, sideroblastic anemia, and lead poisoning. For each condition, it outlines the pathogenesis, clinical features, diagnostic evaluation, and treatment approach. Throughout it emphasizes the importance of obtaining a thorough history and using iron studies, blood counts, and other tests to differentiate between the various microcytic anemia etiologies.Pancytopenia
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油
Pancytopenia is a condition defined by low levels of red blood cells, white blood cells, and platelets. It can be caused by bone marrow failure, bone marrow infiltration, ineffective hematopoiesis, or peripheral destruction/pooling of blood cells. Evaluating the history, examination, blood counts, blood film, bone marrow aspiration/biopsy, and other tests can help determine the underlying cause, such as aplastic anemia, leukemia, lymphoma, or myelodysplastic syndrome. The bone marrow may appear hypocellular, normocellular, or hypercellular, providing clues to diagnoses like aplastic anemia or hematologic malignancies.RBC Histogram
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油
This document discusses red blood cell (RBC) histograms and abnormalities seen in various conditions. It includes histograms showing normal RBC distribution as well as abnormalities seen in conditions like thalassemia major, iron deficiency, and after iron therapy or blood transfusion. The document is authored by Caesar Abu Arra and focuses on interpreting RBC histogram patterns in disease.Similar to Investigations of pancytopenia (20)
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This document provides an evaluation approach for classifying and diagnosing different types of anemia based on patient history and examination findings. It outlines a step-wise approach beginning with determining if the anemia is associated with other hematological abnormalities by examining the bone marrow. It then evaluates the anemia based on red blood cell indices to determine if it is macrocytic, microcytic, or normocytic. For each type of anemia, it provides guidance on further tests and evaluations to identify potential underlying causes. The overall approach is to methodically classify the anemia and then investigate potential etiologies through additional lab tests, bone marrow examination, and considering common associated conditions.A Case of Primary Myelofibrosis
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This case involves a 12-year-old female presenting with weakness, lethargy, and inability to work for 2 months. She had her first menstrual period last month that lasted 20 days and is currently having heavy bleeding on her 15th day of this period. On examination, she has pallor and a heart murmur. Laboratory tests show microcytic anemia. The presentation is suggestive of iron deficiency anemia likely due to heavy menstrual bleeding given her family history of menorrhagia. Further workup is needed to confirm the etiology and guide treatment.ax12.pdfbnhgf xdhgugiuhgiuhhkjhhhhiooloin
ax12.pdfbnhgf xdhgugiuhgiuhhkjhhhhiooloinSARLSAICAMEDICALES
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This document provides information on the diagnosis of anemia. It defines anemia and outlines the grading and classification systems. It discusses the prevalence of anemia globally and in India. The clinical presentation and diagnostic workup are described. Guidelines are provided on evaluating different types of anemia based on red blood cell indices, including iron deficiency anemia, thalassemia, megaloblastic anemia, aplastic anemia, anemia of chronic disease, and hemolytic anemias. Diagnostic testing for specific conditions like sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency are also reviewed. The document emphasizes the importance of anemia as a public health problem and highlights approaches to differentiate between causes of anemia.Diagnosis of Anemia
Diagnosis of Anemia Md Shahid Iqubal
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This document provides information on the diagnosis of anemia. It defines anemia and outlines the grading and classification systems. It discusses the prevalence of anemia globally and in India. The clinical presentation and diagnostic workup are described. Guidelines are provided on evaluating different types of anemia based on red blood cell indices, including iron deficiency anemia, thalassemia, megaloblastic anemia, aplastic anemia, anemia of chronic disease, and hemolytic anemias. Diagnostic testing for specific conditions like sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency is also reviewed.haematological case study
haematological case studyanoop k r
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This document presents 9 cases involving patients presenting with various hematological abnormalities and disorders. The cases include examples of megaloblastic anemia, Fanconi anemia, aplastic anemia, paroxysmal nocturnal hemoglobinuria, acute lymphoblastic leukemia, acute myeloid leukemia with myelomonocytic features, myelodysplastic syndrome, disseminated tuberculosis, hypersplenism and hemophagocytic syndrome. For each case, the patient history, physical findings and diagnostic workup are provided, along with the diagnoses and relevant background information.Anoop k r
Anoop k ranoop k r
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1. A full blood count showed reduced hemoglobin, low white blood cell and platelet counts, and the presence of blast cells.
2. Bone marrow aspiration and biopsy confirmed acute leukemia with the marrow being hypercellular and over 30% blast cells.
3. Cytochemical staining and monoclonal antibodies were used to characterize the leukemia as either acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) based on staining patterns and cell surface markers.Common pitfalls in bone marrow biopsy based diagnostic approach
Common pitfalls in bone marrow biopsy based diagnostic approachspa718
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1. Bone marrow biopsy is the gold standard for diagnosing many hematological diseases but can have pitfalls in interpretation if not done or interpreted properly.
2. Key factors that can limit interpretation include inadequate clinical information, small or distorted specimen, limited staining, and insufficient experience.
3. Specialized ancillary tests like cytogenetics, immunophenotyping, and immunohistochemistry are often needed to make an accurate diagnosis when morphology is inconclusive or to differentiate between possible conditions.
4. A systematic approach incorporating clinical findings and additional test results is important to avoid common pitfalls like misdiagnosing infiltration, fibrosis, or focal lesions.Anaemia Summary
Anaemia SummaryDr. Rubz
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Anaemia is defined as a low haemoglobin level. It can be classified based on the mechanism (decreased red blood cell production or increased red blood cell loss) and mean corpuscular volume (MCV). Common symptoms include fatigue, dyspnea, and palpitations. Signs include pallor, jaundice, and heart murmurs. History should focus on iron loss, diet, medications, and family history. Investigations include full blood count, reticulocyte count, blood film, iron studies, folate, B12, and bone marrow biopsy if needed. The most common cause is iron deficiency due to blood loss. Treatment depends on the underlying cause.Classification of anaemia
Classification of anaemiaAFiFi Faridz
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This document discusses the classification and underlying causes of normochromic normocytic anemia. It covers several specific types including hereditary spherocytosis, pyruvate kinase deficiency, G6PD deficiency, sickle cell disease, antibody-mediated transfusion reactions, and microangiopathic hemolytic anemia. For each condition, it describes key aspects of pathophysiology, clinical features, laboratory findings, diagnosis, and potential treatments. The document provides an overview of approaches for classifying and diagnosing different forms of normochromic normocytic anemia.Cases 2
Cases 2basiohack
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1. A 21 year old man presented with pancytopenia with a Hb of 5.0, WBC of 2.6, neutrophils of 1.1, and platelets of 45. His MCV was elevated at 104.
2. Initial tests such as B12, folate, ferritin, LFTs and virology were normal. A bone marrow aspirate and trephine was performed.
3. The bone marrow aspirate and trephine revealed findings consistent with aplastic anemia, explaining the patient's pancytopenia. Further investigation is needed to determine the underlying cause of the aplastic anemia.Approach to pancytopenia presentation medicone
Approach to pancytopenia presentation mediconemidhat2502
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This document discusses an approach to evaluating and diagnosing pancytopenia. Pancytopenia is defined as a decrease in all three blood cell lines. It outlines criteria for defining pancytopenia in adults and children. It then discusses potential etiologies including bone marrow disorders, systemic diseases, infections, inherited conditions, and acquired aplastic anemia. Specific inherited conditions that can cause pancytopenia like Fanconi anemia are described in detail. The document concludes by presenting several clinical cases to demonstrate approaches to diagnosing different causes of pancytopenia.ABC of c.b.c.
ABC of c.b.c.Qiba Hospital
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This document provides an overview of interpreting complete blood count (CBC) reports and recognizing common blood disorders. It discusses the objectives of CBC testing, components of blood, bone marrow function, factors that can affect CBC results, components of CBC reports like hemoglobin, hematocrit, red blood cell indices, and white blood cell differentials. Common causes of anemia, leukocytosis, thrombocytopenia, and abnormalities seen in blood smears are outlined. The document also provides summaries of common blood disorders like leukemias, highlighting features seen on CBC reports.Hema
HemaEpah Zulkifli
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This document provides an overview of hematology and various blood disorders. It begins with approaches to analyzing blood films and clinical approaches to anemia. It then discusses iron metabolism and deficiencies in detail. Specific topics covered include the phases of hemostasis, hematologic malignancies such as leukemias and lymphomas, and approaches to common blood disorders and anemias. The document provides a comprehensive hematology reference with sections on various blood-related topics, diagnostic indicators, and clinical management approaches.Ad
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Investigations of pancytopenia
- 1. PRESENTED BY-DR.BISWAJEETA SAHA(1ST YR PGT) MODERATOR-DR.S.RAMAN,KIMS,BHUBANESWAR
- 2. DEFINITION Combination of anemia, leucopenia and thrombocytopenia Hb<9g/dl TLC<4000/cmm TPC<1.5 lacs/cmm
- 3. ETIOLOGY Hypocellular marrow Cellular marrow with Primary marrow disease def/syst diseases with cellular marrow Aplastic anemia Vit B12 and folic acid Aleukemic leukemia Hypoplastic MDS deficiency Hairy cell leukemia Post chemotherapy Hypersplenism MDS Fanconis anemia Kala azar Marrow necrosis Diamond-Shwachman SLE,sjogrens Myelofibrosis syndrome syndrome,sarcoidosis PNH Transfusion associated Tuberculosis,brucelosis HPS GVHD Metastatic solid tumors Aplastic crisis in Alcoholism hemolytic anemia Storage diseases Drugs Infections
- 4. Peripheral smear RBC- Normocytic normochromic with few macrocytes,no anisopoikilocytosis,no nRBCs,reticulocytopenia----aplastic anemia Macroovalocytes,howel jolly bodies-megaloblastic anemia Tear drop cells,howel jolly bodies,basophilic stippling--MDS nRBCs,sickle cells-aplastic crisis in sickle cell anemia WBC- Leucopenia,mostly mature lymphocytyes(80-90%)---aplastic anemia Neutrophils present in increased number,with toxic granules,shift to left infections Basophilic stippling,hypersegmented neutrophilsmegaloblastic anemia If blasts presentsubleukemic leukemia Hypogranular neutrophils,pseudo pelger heut anomaly--MDS PLATELETS- Normal TPC rules out aplastic anemia Giant plateletsMDS /hypersplenism
- 5. History taking Duration of symptoms How many blood transfusions,intervals between transfusions h/o hemoglobinuria Dietary history Socio economic status Exposure to Drugs, especially antineoplastic, antibiotics (chloramphenicol, sulphonamides),anti epileptics and antithyroid drugs (Aplastic) barbiturates, phenytoin, and oral contraceptives (B12) Exposure to radiation (Aplastic) Chemical exposure Benzene & insecticides (Aplastic) Infections Viruses (viral hepatitis,EBV, parvovirus, and HIV. (Aplastic)
- 6. Weight loss , fever (malignancy, inflammatory) Jaundice (Hep B & C) Evidence of bleeding Infections TB, Malaria Joint pains SLE
- 7. General physical examination Eye examination Retinal hemorhage Leukemic infiltration Jaundiced sclera(PNH,hepatitis,cirrhosis) Epiphora(dyskeratosis congenita) Oral examination Oral petechaie Stomatitis/chelitis Gingivial hyperplasia Oral candidiasis
- 8. Cardiovascular examination Musculoskelatal system Tachycardia,edema,CCF Short stature Synovitis Respiratory system Abnormal thumb Clubbing Tachypnoea Abdominal examination Hepatomegaly Lymphadenopathy Splenomegaly Skin examination Malar rash Purpura Reticular pigmentation,dysplastic nails(dyskeratosis congenita) Hypopigmented areas hyperpigmentation
- 9. Bone marrow examination Almost almost always indicated in cases of pancytopenia unless the cause is apparent. Both aspiration and biopsy required Sample for cytogenetics and immunophenotyping,culture and serological studies IN THE ASPIRATE: Empty particles,markedly hypocellular,only scattered mature lymphocytes and sometimes plasma cells in excess---aplastic anemia Sometimes pockets of cellularity with widespread hypocellularityevolving phase of aplastic anemia Hypocellular BM with Blasts(>20%)----hypoplastic leukemia Hypocellular BM with Dysplastic megakaryocyteshypoplastic MDS Scattered proerythroblasts with large nuclear inclusions in hypocellular BM parvo virus
- 10. In hypercellular BM Erythroid hyperplasia with megablastosismegaloblastic anemia Trilineage dysplasia with ringed sideroblasts on perl stainMDS Infiltration by RS cellsHL Infiltration with malignant cellsmetastasis In PNH and fanconis anemiaearly stage will show hypercellular normal appearing marrow
- 11. Specific testing pinpoints diagnosis in following conditions Fanconis anemia: diepoxybutane (DEB) test for chromosomal breakage in peripheral blood lymphocyte Lymphoproliferative disorders:immunophenotyping,cytogenetics,lymph node biopsy PNH:peripheral blood immunophenotyping for deficiency of phosphatidylinositol glycan linked molecules on peripheral blood cells(cd 16,cd 55,cd 59),HAMs test CMV:serum IgM,IgG EBV:serum monospot,viral capsid antigen(VCA),Epstein barr nuclear antibody(EBNA) Leishmaniasis:blood and bone marrow culture,ELISA Serum PSA:prostatic ca
- 12. pancytopenia History,examination,CBC,retic count,serum iron/TIBC Blast,hypo Unexplained No specific Hypersegmented Palpable spleen Sepsis/bleeding PMNs,marked with increased retic granular splenomegal finding PMNs y/M anisopoikilocytosis protein/meta stasis Trial of B12 and folic acid No response response Acid hemolysis test Hypersplenism/m alaria/leishmanias is HIV antibody Bone marrow aspiration and biopsy
- 13. CBC AND PS LFT PNH and IBMFS Bone marrow B12/Folate levels investigations biopsy and Coagulation aspirate profile Viral serology Autoimmune profile Bonemarrow Blood/bm cytogenetics immunophen otyping
- 14. THANK YOU