PANCE Blueprint Hematology (5%)


Patient will present as → a 68-year-old woman presents to the emergency department due to fatigue, malaise, and subjective fever. Her symptoms began approximately 1 week ago. Medical history is significant for small cell lung cancer recently treated with doxorubicin plus cyclophosphamide and etoposide. Her temperature is 102°F (38.9°C) and blood pressure is 100/80 mmHg. A complete blood count with differential is remarkable for an absolute neutrophil count of 320 cells/mm3. She is admitted to the hospital and administered intravenous cefepime.

Leukopenia is a decrease in the number of white blood cells (leukocytes) found in the blood, which places individuals at increased risk for infection

  • Neutropenia, a subtype of leukopenia, refers to a decrease in the number of circulating neutrophil granulocytes, the most abundant white blood cells. The terms leukopenia and neutropenia may occasionally be used interchangeably
  • Agranulocytosis is a complete absence of neutrophils - drugs that cause this include clozapine, propylthiouracil, penicillin G, methimazole, and dapsone

Low white cell count may be due to acute viral infections, such as a cold or influenza

  • Associated with chemotherapy, radiation therapy, myelofibrosis, aplastic anemia, stem cell transplant, bone marrow transplant, HIV, AIDS, and steroid use
  • Medical conditions such as systemic lupus erythematosus, Hodgkin's lymphoma, some types of cancer, etc.
  • Medications such as clozapine, bupropion, minocycline, valproic acid, lamotrigine, metronidazole, immunosuppressive drugs, and interferons used to treat MS

Leukopenia can be identified with a complete blood count

  • In adults leukopenia is a total WBC count <3.7 K/ μL (normal WBC count 4.5– 11.0 K/ μL)
  • Neutropenia is defined as an absolute neutrophil count (ANC) of less than 1.5 K/ μL

Additional tests

  • Complete metabolic panel
  • Blood cultures
  • Urine culture
  • Culture of sites concerning for infection
  • Radiologic studies and CT scan

Treatment will be guided by cause

  • Discontinue causative agent, antibiotics in case of neutropenic fever

Vitamin B12 deficiency (Lecture) (Prev Lesson)
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