Aplastic anemia
Revisión del 23:38 30 sep 2019 de ClaireLewis (discusión | contribs.)
Background
- Absence or decreased number of hematopoietic precursor cells → pancytopenia (anemia, thrombocytopenia, neutropenia)
- Causes:
- Drug-induced (chloramphenicol, carbamazepine, valproic acid, phenytoin)
- Viral infection (parvovirus B19, HIV, hepatitis), especially in patients with sickle cell disease or immunocompromise
- Autoimmune
- Congenital (Fanconi anemia)
Clinical Features
- Anemia
- Thrombocytopenia
- Mucosal bleeding, petechiae
- Neutropenia
- Recurrent infections, fever
Differential Diagnosis
Differential Diagnosis
Pancytopenia Causes
- Acute leukemia
- Myelodysplastic syndrome, myelofibrosis
- Aplastic anemia
- Infiltrative disease (e.g. lymphoma, multiple myeloma, metastatic carcinoma)
- Paroxysmal nocturnal hemoglobinuria
- Drugs/treatments (*drugs more commonly associated with pancytopenia)
- Bone marrow irradiation*
- Chemotherapy*(especially anthracyclines, methotrexate)
- Anti-inflammatories (rituximab*, sulfasalazine*, colchicine, azathioprine, methotrexate)
- Antimicrobials (chloramphenicol, ganciclovir, penicillin G*, dapsone*, quinine
- Thiomides (propylthiouracil*, methimazole*, carbimazole)
- Antipsychotics (clozapine*, olanzapine
- Procainamide*
- Cyclophosphamide
- Antiepileptics ([[phenytoin], carbamazepine, phenobarbital)
- Infection
- Tuberculosis
- AIDS
- Leishmaniasis, brucellosis, histoplasmosis.
- Viruses causing aplastic anemia (viral hepatitis, Epstein-Barr virus, HIV, parvovirus B19)
- Systemic lupus erythematosus
- Hypersplenism
- Acute radiation syndrome
Evaluation
- CBC: pancytopenia
- Reticulocyte count: reduced or absent
- Peripheral smear
Management
- Transfuse PRBCs/platelets as needed for severe anemia/thrombocytopenia
- Antimicrobials if febrile and neutropenic
Disposition
- Generally admit