Question 25 from the first paper of 2005 asked the candidates to arrive at a series of sensible differentials to explain a case of pancytopenia in a 68 year old man with diffuse bilateral pulmonary infiltrates. Question 23.3 from the second paper of 2015 examines the cause of a pancytopenia in a patient with multi-organ system failure in the context of pneumonia and sepsis.
Readable literature for this topic needs to include the following sources:
These have been condensed into the table offered below:
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Bone marrow biopsy is the investigation of choice for pancytopenia.
It will rapidly narrow the list of differentials, at least if one is able to catch some cells in one's sample. Occasionally, one finds a pocket of totally acellular marrow, which - though ominously prognostic - is frequently useless diagnostically. The most likely cause of pancytopenia is acute lymphoblastic leukaemia in children and acute myeloid leukaemia/myelodysplastic syndrome in adults.
Kufe, Donald W., et al. "Causes of Pancytopenia." (2003). Holland-Frei Cancer Medicine. 6th edition. Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Hamilton (ON): BC Decker; 2003.
Khodke, Kishor, et al. "Bone marrow examination in cases of pancytopenia."Indian Academy of Clinical Medicine 2 (2001): 1-2.
Gayathri, B. N., and Kadam Satyanarayan Rao. "Pancytopenia: A clinico hematological study." Journal of laboratory physicians 3.1 (2011): 15.
Weinzierl, Elizabeth P., and Daniel A. Arber. "The differential diagnosis and bone marrow evaluation of new-onset pancytopenia." American journal of clinical pathology 139.1 (2013): 9-29.
Marsh, Judith CW, et al. "Guidelines for the diagnosis and management of aplastic anaemia." British journal of haematology 147.1 (2009): 43-70.