A 61 year old man presents critically unwell with

neutropaenic sepsis and severe pancytopaenia

Mild hyponatraemia, hypokalaemia and hypocalcaemia

requiring resuscitation, early broad spectrum antibiotics, correction of electrolytes and investigation of the cause of his pancytopaenia.

Early discussion with haematology regarding specific blood tests prior to blood transfusion, possible need for Immunoglobulin transfusion and platelets (if risk of bleeding)

Definition of Pancytopaenia:

Hb<100 or Retic count <40

WCC < 4, N <1.5

Plt < 150

Acquired causes of Pancytopaenia:

Decreased bone marrow function

Aplastic anaemia

Acute leukaemia, myelodysplasia, myeloma

Infiltration with lymphoma, solid tumours,

Sepsis – Tuberculosis, Kala Azar, Brucellosis, overwhelming sepsis

Megaloblastic anaemia – alcohol, B12, folic acid

Paroxysmal nocturnal haemoglobinuria

Myelofibrosis

Haemophagocytic syndrome

Drugs – chemotherapy/ radiotherapy

Multiple myeloma

Autoimmune – sarcoid, SLE, sjogrens

Increased peripheral destruction

Splenomegaly

History and examination is aimed at excluding the relevant differential diagnosis

Investigations (guided by history and examination):

FBC and blood smear

ESR – multiple myeloma, infection, auto immune, macroglobulinaemia

Blood cultures

B12/ folate

LFT, UEC, Coags

Hepatitis, HIV, EBV

Auotimmune screen

bone marrow biopsy

other – based on individual patient/ differential diagnosis