HNY Policy and Pathway Repository - York

Pancytopenia is when there is a reduction in all 3 cell lines in the blood count

Consider reversible causes

• Drugs eg methotrexate
• Haematinic deficiency
• Hypersplenism / liver disease

None provided

Investigations

• Vitamin B12/folate
• Reticulocytes
• UEs/LFT
• Bone profile
• Blood film if not already available
• Myeloma screen
• Autoimmune screen

 

Management

If film shows blasts, leucoerythroblastic or patient unwell / febrile/ bleeding symptoms – discuss directly with oncall haematologist

Assess severity

Severe if: Hb < 80g/l or Neutrophils < 0.5 x 10⁹ /l or Platelets < 30 x 10⁹ /l

• Non severe and no clear cause – routine referral to haematology
• Severe but stable – if no clear cause refer on 2 week wait

If possible cause treat and discuss with haematology

If clear cause eg B12 deficiency treat and monitor to ensure resolution

None provided