11. Vit B12 Dificiency aneamia
We can do further
investigations to confirm the
cause
Intrinsic factor antibody test
Schilling test
Upper gastro intestinal endoscopy
History taken
Folate Dificiency anaemia
Red cell folate test
Serum folate test
12. Some of main causes are
Excess alcohol
Liver disease
Aplastic anaemia
Hypothyroidism
Drugs
This causes can confirmed
by History taken of the
patient
22. PANCYTOPENIA AT INITIAL
EVALUATION
REFER PATIENT FOR URGENT
EVALUATION
REPEAT CBC AND BLOOD SMEAR
BONE MARROW ASPIRATE
ANDTREPHINE BIOPSY
BONE MARROW CYTOGENETICS
BONE MARROW
IMMUNOPHENOTYPING
LFT,B12 AND FOLATE,COAGULATION
PROFILE,VIRAL
ETIOLOGY,AUTOIMMUNE PROFILE
23. 1. APLASTIC ANEMIA
2. HYPOPLASTIC
MYELODYSPLASTIC SYNDROME
3. LYMPHOMA IN HYPOPLASTIC
BONE MARROW
4. CYTOTOXIC AGENTS AND
RADIOTHERAPY
VERY RARE- ACUTE LEUKEMIA IN
HYPOPLASTIC BONE MARROW
26. Normal distribution and
cellularity are seen
Normal bone marrow
biopsy
Aplastic patient
a – bone marrow aspiration
a ̶ bone marrow biopsy
Hypocellularity can be seen
Aplastic anaemia
27. TEST RATIONALE
BONE X-RAYS Multiple myeloma, metastasis.
BLOOD CULTURE Infectious agent- Tuberculosis or virus.
VITAMIN B12 AND FOLATE ASSAYS Megaloblastic anemia
ASPARTATE AMINOTRANSFERASE,
ALANINE AMINOTRANSFERASE,
GAMMA GLUTAMYL
TRANSFERASE, BILIRUBIN
Evaluate hepatitis
BLOOD UREA NITROGEN,
CREATININE
Assess for Chronic Renal Failure
SEROLOGY For HIV, EBV, Hepatitis
HAM’S TEST Paroxysmal Nocturnal Haemoglubinuria
CHROMOSOMAL BREAKAGE
STUDIES
Fanconi anemia
36. Monoclonal antibodies(McAb) are recognised
under a cluster of differentiation(CD).
MONOCLONAL ANTIBODIES USED FOR
CHARACTERISATION OF ALL AND AML.
Monoclonal antibodies
AML : CD13, CD33
ALL : B-ALL CD10, CD 19, CD22
T-ALL CD3, CD7