Term used to describe concurrent decrease in circulating erythrocytes, leukocytes, and thrombocytes
Rare in horses
Usually associated with disrupted hematopoiesis due to either a failure of stem cells to undergo differentiation (aplastic anemia) or destruction of the bone marrow microenvironment by neoplastic, fibrous, or inflammatory diseases (myelophthisis)
Signalment
N/A
Signs
Clinical signs reflect inadequate numbers of functional cells in blood or tissues and are usually nonspecificweight loss, lethargy, poor performance, and intermittent pyrexia
Onset is often insidious
Hemorrhage due to thrombocytopeniapetechiation, epistaxis, mucosal bleeding, blood in feces, or prolonged bleeding from wounds
Mucous membrane pallor, tachycardia, and systolic heart murmur with marked anemia
Secondary infections due to leukopenia
Causes and Risk Factors
Aplastic anemia may be congenital or acquired and can result from intrinsic stem cell failure or disruption of stem cell interactions in the bone marrow. It is often idiopathic, but is rarely associated with administration of drugs (e.g. phenylbutazone, chloramphenicol, estrogens, trimethoprim, or pyrimethamine) or secondary to infectious disease (e.g. EIA virus or Anaplasma phagocytophilum)
Myelophthisis has been associated with myelofibrosis, myelodysplasia, myeloproliferative disorders, or lymphoproliferative disorders
Hemorrhage from vasculitis or thrombocytopenia unassociated with bone marrow dysfunction
Lethargy, pallor, petechiae, and edema may occur in piroplasmosis (Babesia caballi or Theileria equi infection)
Familial megakaryocytic and myeloid hypoplasia in Standardbred horses
Concurrent immune-mediated anemia and thrombocytopenia
CBC/Biochemistry/Urinalysis
Anemia, thrombocytopenia, and leukopenia
Leukopeniaprimarily due to a neutropenia without a left shift
Lymphocyte count may be normal
Anemia occurs after other derangements due to longer lifespan of erythrocytes (≈140 days) compared with thrombocytes (≈5 days) and neutrophils (≈12 h)
Examination of blood smears for A. phagocytophilum morulae in neutrophils, erythrocyte parasites (B. caballi, T. equi), absence of platelets, or abnormal leukocytes in leukemia
Other Laboratory Tests
SerologyB. caballi, T. equi, or A. phagocytophilum
Coggins testEIA
Coombs test
Imaging
Radiography of the skeleton and thoraxmultiple myeloma
Abdominal and thoracic ultrasonographylymphoproliferative disorders
Other Diagnostic Procedures
Bone marrow aspiration/biopsy
Obtain from the sternum or proximal rib (adults) and sternum, rib, or tuber coxae (foals)
Biopsies best for confirmation of bone marrow hypoplasia and myelofibrosis
Normal myeloid to erythroid ratio is 0.51.5: <0.5 suggests a regenerative erythrocyte response or myeloid hypoplasia
Urine protein electrophoresis for detection of Bence Jones proteins in multiple myeloma
Serum protein electrophoresismonoclonal gammopathy suggests lymphoproliferative neoplasia
Immunophenotypic techniques for classification of leukemia
Pathologic Findings
Variable, dependent on the cause of pancytopenia
Leukoproliferative disordersneoplastic cells in bone marrow samples
Myelofibrosisreplacement of bone marrow with fibrous tissue
Aplastic anemiahypocellularity and fat infiltration of bone marrow