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Hematocytopenia: Pancytopenia and Lineage-Specific Cytopenias

Hematocytopenia (more commonly termed pancytopenia when all three lineages are reduced) is a condition characterized by decreased numbers of one or more blood cell lines: erythrocytes (anemia), leukocytes (leukopenia), and/or platelets (thrombocytopenia).

Lineage-Specific Definitions

Term Cell Line Key Threshold (Adults)
Anemia / Erythrocytopenia Red blood cells / Hemoglobin Hb <13 g/dL (M), <12 g/dL (F)
Leukopenia Total white blood cells <4,000/µL
Neutropenia Neutrophils (ANC) <1,500/µL (mild), <500/µL (severe)
Lymphopenia Lymphocytes <1,000/µL
Thrombocytopenia Platelets <150,000/µL

Etiology (Mechanism-Based)

  • Decreased production (bone marrow failure): Aplastic anemia, MDS, leukemia, infiltration (metastasis, fibrosis), nutritional (B12, folate, iron), toxins (benzene, chemo), viruses (parvovirus, HIV).
  • Increased destruction/sequestration: Immune (ITP, AIHA, Evans), TTP/HUS, DIC, hypersplenism, mechanical (valves).
  • Ineffective production: Megaloblastic anemia, myelodysplasia.

Clinical Presentation

  • Anemia: Fatigue, pallor, dyspnea, tachycardia.
  • Neutropenia: Fever, infections (mucosal, skin, sepsis).
  • Thrombocytopenia: Petechiae, ecchymoses, mucosal bleeding, hemorrhage.

Diagnostic Workup

  1. CBC with differential, peripheral smear (morphology, blasts, schistocytes).
  2. Reticulocyte count (production vs. destruction).
  3. Bone marrow aspiration/biopsy (cellularity, dysplasia, infiltration).
  4. Targeted labs: B12, folate, iron, LDH, haptoglobin, Coombs, viral serologies, autoimmune panel.

Treatment Principles

  • Treat underlying cause.
  • Transfusion support (RBCs, platelets) for symptomatic/severe cytopenias.
  • Growth factors: G-CSF (neutropenia), ESA (anemia), TPO agonists (thrombocytopenia).
  • Immunosuppression (IST) for aplastic anemia, immune cytopenias.
  • Stem cell transplant for refractory/severe marrow failure.

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