Pancytopenia

• Pancytopenia: ↓ in all cell lines

• “Hypoplasia”: abnormally low proportion of hematopoietic stem cells, which are replaced by adipose tissue

• “Aplastic anemia”: pancytopenia due to hypoplasia

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• In the assessment of pancytopenia, peripheral destruction is usually the last bucket to consider as the probability of a marrow issue trumps the probability of a destruction issue when more cell lines are down

• Every pancytopenia work-up should include a blood smear & hemolysis work-up. If the latter work-up is ⊕, you may be pointed toward destructive causes earlier than you would’ve expected. If the hemolysis work-up is ⊖, smear findings may point you directly toward a cell maturation issue (i.e. ineffective hematopoiesis bucket) or marrow replacement issue (i.e. infiltration)

• Leukoerythroblastosis → Marrow Infiltration: “leukoerythroblastosis” refers to the finding of immature WBCs (myelocytes, metamyelocytes) & nucleated/immature RBCs ⊕/⊖ tear drop cells due to infiltration-mediated marrow crowding, which forces immature cells out into the periphery. The resultant ↑ variation in peripheral cell sizes results in anisocytosis

• RBC inclusions → Ineffective Hematopoiesis: a variety of inclusions can be seen in diseases that cause ineffective hematopoiesis, as improper late-phase RBC maturation results in impaired expulsion of different RBC contents (ribosomes = basophilic stippling, iron = pappenheimer bodies, nuclear remnants = Howell-Jolly bodies, mitotic spindle = Cabot rings)

• “Smear ⊖”: if the smear leaves you no clues, hypoplastic etiologies should be considered

• A syndrome that captures the findings of leukoerythroblastosis ⊕/⊖ extramedullary hematopoiesis (compensatory hematopoiesis resulting in hepatosplenomegaly) occurring due to marrow infiltration

• @AndreMansoor

• @RLRCPSolvers

• Red Blood Cell Inclusions (The Blood Project)

• The Complexities of Diagnosis with Co-Existing Gaucher Disease and Hemato-Oncology—A Case Report and Review of the Literature

• Generalized crystal-storing histiocytosis associated with monoclonal gammopathy: molecular analysis of a disorder with rapid clinical course and review of the literature

• Generalized crystal-storing histiocytosis associated with monoclonal gammopathy: molecular analysis of a disorder with rapid clinical course and review of the literature

• Case 7-2025: A 65-Year-Old Woman with Weakness, Back Pain, and Pancytopenia (NEJM)

• Leukoerythroblastosis: a much maligned phenomenon?

• Scurvy's Systemic Clinical Picture: A Multiorgan Presentation of a Conspicuous Disease

• ASH Figure, X Figure