74-year-old male has suffered over six months from pancytopenia. The main problem has been the symptomatic anemia, which required blood transfusions. Bone marrow aspiration revealed some myelodysplasia, and immune therapy has been prescribed. The expert suggests possible differential diagnosis of pancytopenia and recommends to establish a definite diagnosis before discussing treatment.
The patient asks about the differential diagnosis of pancytopenia and the treatment options.
- Vascular surgery (peripheral vascular disease ?)
- Colon polypectomy
- Myelodysplastic syndrome (MDS): The age, pancytopenia, the high MCV and some myelodysplasia in the marrow – all consistent with this diagnosis.
However, this should be confirmed by bone marrow analysis by an expert, also with at least cytogenetic analysis.
- Liver disease with cirrhosis – this should be tested by blood tests (liver function tests, serology) ultrasound and sometimes liver biopsy (if indicated).
- Immune pancytopenia, whether primary hematological disease, or secondary to connective tissue disease / vasculitis or secondary to lymphatic disease.
- Other primary bone marrow diseases such as aplastic / hypoplastic anemia, PNH, myeloproliferative disease and others. BM analysis and specific tests can help.
- Megaloblastic anemia – B12 and / or folic acid deficiency
- Drug induced or viral induced (B19, EBV, CMV) BM suppression
Missing information / Documents:
- History – symptoms, clinical picture
- Routine blood tests – especially chemistry
- Bone marrow report
- Anemia work up
- GI work up
- Specific tests – see above