Case Presentation – Hematology 3


A 45-year-old woman presented to the clinic with several concerning symptoms:

  • Chief Complaints: Fatigue, frequent infections, and easy bruising over the past few months.
  • Medical History: Unremarkable, with no chronic illnesses or prior surgeries.
  • Social History: No recent travel, no exposure to known toxins.
  • Family History: No family history of hematological disorders.
  • Medications: No current medications or recent use of potentially myelosuppressive drugs.

General Examination

On physical examination, the following findings were noted:

  • Appearance: The patient appeared pale and slightly jaundiced.
  • Skin: Presence of petechiae on lower extremities, indicative of possible thrombocytopenia.
  • Vital Signs: Stable, with no fever, hypotension, or tachycardia.

Systemic Examination

A detailed systemic examination revealed:

  • Lymphatic System: No lymphadenopathy was detected.
  • Abdomen: Mild splenomegaly was noted upon palpation.
  • Cardiovascular and Respiratory Systems: Normal heart sounds and clear lungs, with no signs of heart failure or respiratory distress.

Laboratory Reports

Initial laboratory tests provided key insights:

  • Complete Blood Count (CBC):
    • Hemoglobin: 8 g/dL (low)
    • White Blood Cell Count: 2,000/µL (low)
    • Platelet Count: 50,000/µL (low)
  • Reticulocyte Count: Low, indicating reduced production of red blood cells.
  • Peripheral Blood Smear: Showed pancytopenia without the presence of abnormal cells.
  • Liver and Renal Function Tests: Within normal limits.
  • Viral Serologies: Negative for HIV, hepatitis B and C, and Epstein-Barr virus.

Peripheral Smear and Bone Marrow Examination

Further investigation with peripheral smear and bone marrow biopsy revealed:

  • Peripheral Smear: Confirmed pancytopenia with normocytic, normochromic red cells, and absence of immature or abnormal white cells.
  • Bone Marrow Biopsy: Hypocellular marrow with a marked decrease in hematopoietic cells and no evidence of malignancy, suggesting a diagnosis of aplastic anemia.


Pancytopenia is characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets. This condition can arise from various underlying causes, necessitating a detailed diagnostic approach.

Causes of Pancytopenia

Pancytopenia can result from several etiologies, including:

  • Bone Marrow Disorders: Such as aplastic anemia, myelodysplastic syndromes, and leukemia.
  • Infections: Including HIV, hepatitis, and Epstein-Barr virus.
  • Nutritional Deficiencies: Particularly vitamin B12 or folate deficiency.
  • Medications and Toxins: Including chemotherapy, certain antibiotics, and exposure to radiation or benzene.
  • Autoimmune Diseases: Such as systemic lupus erythematosus (SLE).

Approach to Pancytopenia

The approach to a patient with pancytopenia involves:

  1. Detailed History and Physical Examination: Identifying signs of chronic illness, drug use, and exposure to toxins or infections.
  2. Laboratory Tests: Conducting CBC, reticulocyte count, and peripheral blood smear as initial tests. Further tests may include liver and renal function tests and viral serologies.
  3. Bone Marrow Examination: Performing a bone marrow biopsy to assess cellularity and detect abnormal cells.
  4. Specialized Tests: Utilizing tests like flow cytometry, cytogenetic analysis, and autoantibody panels based on suspected causes.

Management of Pancytopenia

Treatment strategies are tailored to the underlying cause:

  • Aplastic Anemia: Managed with immunosuppressive therapy and bone marrow transplantation.
  • Nutritional Deficiencies: Treated by supplementing the deficient vitamins (B12 or folate).
  • Infectious Causes: Addressed by treating the underlying infection.
  • Drug-induced Pancytopenia: Managed by discontinuing the offending drug and providing supportive care.


Pancytopenia is a complex condition that requires a thorough diagnostic and management approach.

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