Summary
Pancytopenia is a condition in which there is a lower-than-normal number of red and white blood cells and platelets in the blood. The spectrum of causes for the decrease of one or more blood cell lineages is broad including increased destruction, pooling by spleen, loss of blood cells, decreased production due to toxic and/or immune-mediated mechanisms and abnormalities due to clonal/malignant hematopoiesis. In this article common and/or typical causes of pancytopenia are presented with special emphasis on more or less disease specific features that may be useful clues in the differential diagnosis of this blood picture abnormality.
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References
Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol. 2013;139:9–29.
Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumors of haematopoietic and lymphoid tissues. 2017.
Lowenberg B, Downing JR, Burnett A. Acute myeloid leukemia. N Engl J Med. 1999;341(14):1051–62. https://doi.org/10.1056/NEJM199909303411407.
Friedman RB, Anderson RE, Entine SM, Hirshberg SB. Effects of diseases on clinical laboratory tests. Clin Chem. 1980;26(4 Suppl):1D–476D.
Warrell RP Jr, de Thé H, Wang ZY, et al. Acute promyelocytic leukemia. N Engl J Med. 1993;329(3):177–89. https://doi.org/10.1056/NEJM199307153290307.
Lo-Coco F, Avvisati G, Vignetti M, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369(2):111–21. https://doi.org/10.1056/NEJMoa1300874.
Young NS. Aplastic Anemia. N Engl J Med. 2018;379(17):1643–56. https://doi.org/10.1056/NEJMra1413485.
Spivak JL. Fundamentals of clinical hematology. 2nd ed. New York: Harper & Row; 1984.
Ohler L, Geissler K, Hinterberger W. Diagnostic and prognostic value of colony formation of hematopoietic progenitor cells in myeloid malignancies. Wien Klin Wochenschr. 2003;115(13–14):537–46. https://doi.org/10.1007/bf03041036.
Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982;51(2):189–99.
Cazzola M. Myelodysplastic syndromes. N Engl J Med. 2020;383(14):1358–74. https://doi.org/10.1056/NEJMra1904794.
List A, Dewald G, Bennett J, et al. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med. 2006;355(14):1456–65. https://doi.org/10.1056/NEJMoa061292.
Cervantes F, Barosi G. Myelofibrosis with myeloid metaplasia: diagnosis, prognostic factors, and staging. Semin Oncol. 2005;32(4):395–402. https://doi.org/10.1053/j.seminoncol.2005.04.011.
Takeda J, Miyata T, Kawagoe K, et al. Deficiency of the GPI anchor caused by a somatic mutation of the PIG‑A gene in paroxysmal nocturnal hemoglobinuria. Cell. 1993;73(4):703–11. https://doi.org/10.1016/0092-8674.
Hillmen P, Lewis SM, Bessler M, Luzzatto L, Dacie JV. Natural history of paroxysmal nocturnal hemoglobinuria. N Engl J Med. 1995;333(19):1253–8. https://doi.org/10.1056/NEJM199511093331904.
Toh B‑H, van Driel IR, Gleeson PA. Pernicious anemia. N Engl J Med. 1997;337(20):1441–8. https://doi.org/10.1056/NEJM199711133372007.
De Aizpurua HJ, Cosgrove LJ, Ungar B, Toh B‑H. Autoantibodies cytotoxic to gastric parietal cells in serum of patients with pernicious anemia. N Engl J Med. 1983;309(11):625–9. https://doi.org/10.1056/NEJM198309153091102.
Bethel KJ, Sharpe RW. Pathology of hairy-cell leukaemia. Best Pract Res Clin Haematol. 2003;16(1):15–31. https://doi.org/10.1016/s1521-6926(02)00087-7.
Tiacci E, Trifonov V, Schiavoni G, et al. BRAF mutations in hairy-cell leukemia. N Engl J Med. 2011;364(24):2305–15. https://doi.org/10.1056/NEJMoa1014209.
Koskela HLM, Eldfors S, Ellonen P, et al. Somatic STAT3 mutations in large granular lymphocytic leukemia. N Engl J Med. 2012;366(20):1905–13. https://doi.org/10.1056/NEJMoa1114885.
Liu JH, Wei S, Lamy T, et al. Chronic neutropenia mediated by fas ligand. Blood. 2000;95(10):3219–22.
Pascutti MF, Erkelens MN, Nolte MA. Impact of viral infections on hematopoiesis: from beneficial to detrimental effects on bone marrow output. Front Immunol. 2016;16(7):364. https://doi.org/10.3389/fimmu.2016.00364.
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Geissler, K. Pancytopenia—a diagnostic challenge?. memo 14, 355–359 (2021). https://doi.org/10.1007/s12254-021-00757-7
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DOI: https://doi.org/10.1007/s12254-021-00757-7