Pancytopenia: Clues from the Peripheral Blood Film
Diagnosis | Typical blood film findings |
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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 |