From the Research
The approach to a 61-year-old female with pancytopenia and abnormal lab values should begin with a comprehensive hematologic evaluation including bone marrow biopsy and aspiration, as evidenced by the most recent study 1. This is essential to differentiate between primary bone marrow disorders and secondary causes. Initial workup should include:
- Complete blood count with differential
- Peripheral blood smear
- Reticulocyte count
- Comprehensive metabolic panel
- Coagulation studies
- Vitamin B12, folate, and iron studies Specific testing for myelodysplastic syndromes, leukemia, and aplastic anemia should be performed, including cytogenetic analysis and flow cytometry of the bone marrow sample, as recommended by 2. While awaiting results, supportive care may include:
- Transfusions of packed red blood cells for symptomatic anemia (typically when hemoglobin falls below 7-8 g/dL)
- Platelet transfusions for counts below 10,000/μL or if bleeding occurs
- Consideration of granulocyte colony-stimulating factors for severe neutropenia with infection Medications that could potentially cause bone marrow suppression should be discontinued if possible, as suggested by 3. The patient should be monitored closely for infections, with prompt initiation of broad-spectrum antibiotics (such as piperacillin-tazobactam 4.5g IV every 6 hours) for febrile neutropenia. Definitive treatment will depend on the underlying cause, ranging from immunosuppressive therapy for autoimmune processes to chemotherapy for malignancies or hematopoietic stem cell transplantation for certain conditions, as discussed in 4 and 5. This systematic approach is crucial as pancytopenia represents a serious condition with multiple potential etiologies requiring different management strategies, highlighted by the case report in 1.