Trans OS216 Hema 15

OS 2 16

Bone Marrow Failure States

HEMATOLOGY

Dr. Beatrice J. Tiangco

Trans 15 | Exam 1

Block B

OUTLINE I. II. III. IV. V. VI. VII. VIII. IX. X.

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A. DIFFERENTIAL DIAGNOSIS OF PANCYTOPENIA AND BONE MARROW HYPOCELLULARITY

A 14 year old boy presents with sore throat, rash, gum bleeding. He was well until three weeks ago. The throat was red. His legs have petechiae. No lymphadenopathy, no organomegaly, with temperature of 38 C. Labs:

Clinical disorder defined by pancytopenia and bone marrow hypocellularity Must be differentiated from other disease conditions presenting with pancytopenia and hypocellular marrow

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Clinical Case

I

Aplastic Anemia (AA)

III

Clinical Case Bone Marrow Failure Aplastic Anemia Severe Aplastic Anemia Transfusion Principles for Managing Aplastic Anemia Pure Red Cell Aplasia (PRCA) Acquired Pure Amegakaryocytic Thrombocytopenic Purpura (APATP) Pure White Cell Aplasia Myelodysplastic Syndrome (MDS) Anemia of Chronic Disease (ACD)

Hb: 8.9g/dl Hct: .30 MCV: 103 fL WBC: 2,200/L Neutrophil: 10-20 Lymphocytes: 80 Platelet: 18,000 Reticulocyte count: 1%

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Idiopathic Aplastic Anemia Inherited Aplastic Anemia Hypocellular Myelodysplasia Aleukemic Leukemia Paroxysmal Nocturnal Hemoglobinuria Myelofibrosis Hairy Cell Leukemia Tuberculosis Anorexia Nervosa

B. KEY POINTS IN THE DIAGNOSTIC APPROACH FOR PATIENTS WITH PANCYTOPENIA *

History including medications, previous chemotherapy and radiotherapy, occupational toxic exposure and family history Physical Examination paying attention to presence of organomegaly, lymphadenopathy, musculoskeletal abnormalities CBC including absolute reticulocyte count and peripheral smear LFT, hepatitis serologies, Vit B12, Folate Bone Marrow Aspirate and Biopsy Cytogenetic studies for congenital forms Chromosomal fragility if