Today we heard a case of a patient presenting with symptomatic anemia and thrombocytopenia (with co-incidental leukopenia).I have blogged about my approach to isolated anemia and thrombocytopenia. The combination of the two suggests a number of processes:
Decreased Production:
- Bone Marrow Problem: Leukemia, Lymphoma, Myeloma, Myelodysplastic Syndromes, Myelofibrosis, Myelopthysis, Aplastic Anemia
- Substrate Deficiency: B12/Folate, copper
- Toxin: ETOH, Methotrexate, Chemotherapy, Phenytoin, Heavy Metal Poisoning, etc.
- Infection: Miliary TB, disseminated fungal infection, HIV, Parvovirus B19 (usually just anemia!)
Increased Destruction:
- Microangiopathic haemolytic anemia
- Hypersplenism
- Evan's Syndrome (AIHA and ITP) or associated with collagen vascular disease
The key in distinguishing is looking at the reticulocyte count and then, if low or abnormally normal, performing a bone marrow biopsy. In this case there was a "dry tap" -- which can occasionally be due to inadequate technique -- but often is a sign of a "packed marrow" with leukemic/lyphoma, metastatic cancer, or granulomas (TB).
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