Differential Diagnosis for Pancytopenia in Older Adults

Single Most Likely Diagnosis

• Myelodysplastic Syndrome (MDS): This is a common cause of pancytopenia in older adults, characterized by ineffective hematopoiesis leading to a decrease in all blood cell lines. The age-related decline in bone marrow function and the increased incidence of MDS with age make it a leading consideration.

Other Likely Diagnoses

• Vitamin B12 or Folate Deficiency: These deficiencies can lead to ineffective erythropoiesis and, consequently, pancytopenia. They are common in older adults due to decreased dietary intake, malabsorption, or increased demand.
• Chronic Diseases (e.g., Chronic Infections, Rheumatologic Diseases): Chronic diseases can lead to pancytopenia through mechanisms such as bone marrow suppression or sequestration of cells in the spleen.
• Medication-Induced Bone Marrow Suppression: Various medications, including chemotherapeutic agents, antibiotics, and anticonvulsants, can suppress bone marrow function, leading to pancytopenia.

Do Not Miss Diagnoses

• Aplastic Anemia: Although less common, aplastic anemia is a potentially life-threatening condition that requires prompt diagnosis and treatment. It is characterized by a failure of the bone marrow to produce blood cells.
• Paroxysmal Nocturnal Hemoglobinuria (PNH): PNH is a rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombotic events.
• Leukemia (e.g., Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia): Leukemias can present with pancytopenia due to bone marrow infiltration by malignant cells. Early diagnosis is crucial for treatment and prognosis.

Rare Diagnoses

• Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency, which can cause pancytopenia. It's less common but important to consider in the differential diagnosis.
• Congenital Bone Marrow Failure Syndromes (e.g., Fanconi Anemia): These are rare genetic disorders that affect the bone marrow's ability to produce blood cells. While more commonly diagnosed in children, some forms may not be recognized until adulthood.
• Glycogen Storage Disease Type Ib: A rare genetic disorder that can lead to neutropenia and sometimes pancytopenia due to impaired glucose-6-phosphate transport in neutrophils and other cells.