Pancytopenia: Clues from the Peripheral Blood Film
| Diagnosis | Typical blood film findings |
|---|---|
| Acute leukaemia | Pancytopenia, with or without a population of blast cells Specific morphological features may help differentiate between myeloid and lymphoblastic leukaemia, and may raise the suspicion of acute promyeloblastic leukaemia |
| Lymphoma | Variable; possible circulating lymphoma cells (e.g. CLL, mantle cell lymphoma, hairy cell leukaemia); possible leucoerythroblastic change (nucleated red blood cells, myelocytes) |
| Myelofibrosis | Cytopenias with prominent red cell changes, including teardrop poikilocytes, nucleated red cells |
| Myelodysplasia | Variable red cell size and shape; hypogranular and abnormally segmented neutrophils |
| Metastatic malignancy | Leucoerythroblastic film (nucleated red blood cells, myelocytes) |
| B12 or folate deficiency | Oval macrocytes, hypersegmented neutrophils |
| Liver disease | Macrocytosis, target-form red cells |
| Acute viral infection (EBV, CMV) | Atypical lymphocytes; polychromasia/spherocytes if haemolysis |