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 neutrophils—megaloblastic anemia
If blasts present—subleukemic leukemia
Hypogranular neutrophils,pseudo pelger heut anomaly--MDS
PLATELETS-
Normal TPC rules out aplastic anemia
Giant platelets—MDS /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
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 hypocellularity—evolving
phase of aplastic anemia
Hypocellular BM with Blasts(>20%)----hypoplastic leukemia
Hypocellular BM with Dysplastic megakaryocytes—hypoplastic MDS
Scattered proerythroblasts with large nuclear inclusions in hypocellular BM—
parvo virus
10. In hypercellular BM
Erythroid hyperplasia with megablastosis—megaloblastic anemia
Trilineage dysplasia with ringed sideroblasts on perl stain—MDS
Infiltration by RS cells—HL
Infiltration with malignant cells—metastasis
In PNH and fanconis anemia—early 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