Pancytopenia
Pancytopenia
[!important] The underlying cause of pancytopenia was identified as AML with myelodysplasia-related gene mutations (diagnosed November 2025). See Aml for full details including molecular profile and treatment.
Clinical Summary
Ishamma T M presented with pancytopenia — simultaneous reduction in all three blood cell lines (red cells, white cells, and platelets). This was identified through serial CBC testing beginning in late 2025. The underlying cause was identified as Acute Myeloid Leukemia (AML) with myelodysplasia-related gene mutations through bone marrow biopsy, flow cytometry, and next-generation sequencing. Treatment with Azacitidine + Venetoclax was initiated in late November / early December 2025, with progressive improvement in all cell lines.
Key Laboratory Findings
| Date | Hemoglobin | WBC | Platelets | Source |
|---|---|---|---|---|
| 2025-11-17 | — | — | — | Peripheral blood film at KIMS |
| 2025-11-19 | 8.3 g/dL (L) | 2,320 (L) | 70K (L) | DDRC Agilus |
| 2025-11-28 | 6.8 g/dL (L) | 2,500 (L) | 45K (L) | KIMS Health |
| 2026-04-06 | 11.6 g/dL (L) | 5,400 (N) | 131K (L) | KIMS Health |
Peripheral Blood Smear (2025-11-17, KIMS)
Referred by Dr. Mithun Padmanabhan. Findings awaiting full extraction.
Peripheral Blood Smear (2025-11-19, DDRC Agilus)
- RBC: Mostly normocytic normochromic. Few cells show mild hypochromia and anisocytosis. Few microcytes, elongated cells, and ovalocytes. Polychromic RBC (+).
- WBC: Count mildly decreased (2,000–3,000/cumm approx). Eosinophil predominance (13%). Few atypical (reactive) lymphocytes (3%). Occasional band form.
- Platelets: Count mildly decreased (60,000–80,000/cumm approx). Seen singly. Occasional giant form.
- Impression: Normochromic normocytic picture. Leucopenia with relative eosinophil predominance. Thrombocytopenia.
- Reported by: Dr. Vaishali Rajan, MBBS DCP (Pathology)
Bone Marrow Biopsy (2025-11-20, KIMS)
See Bone Marrow Biopsy 2025 11 20 for full details.
- Fragmented marrow tissue with crushing
- 60% cellularity with atypical mononuclear cell infiltrate admixed with normal hematopoietic precursors
- Reticulin Grade 1–2
- Recommendation: Follow bone marrow aspiration / flow cytometry report
Autoimmune Workup (2025-11-19)
- ANA: 2.2 (positive, ref <1.0) — see Positive Ana
- Anti-dsDNA: 29.1 IU/ml (negative, ref <100)
- Anti-CCP: <7.00 U/mL (negative)
- ESR: 130 mm/hr (markedly elevated)
- CRP: 13.80 mg/L (elevated, ref <5)
- Complement C3: 140.0 mg/dL (normal)
- Complement C4: 39.3 mg/dL (normal)
- Ceruloplasmin: 29.10 mg/dL (normal)
Clinical Course
[!success] RESOLVED — May 4, 2026
All three cell lines normalized: Hb 11.9 g/dL (approaching threshold 12.0), WBC 4000 (N), ANC 2360 (N), Plt 213K (N). Pancytopenia resolved after ~5 months of Azacitidine + Venetoclax. See Hemoglobin, Wbc, Platelet Count.
The pancytopenia was improving as of 2026-04-06 (Hb 11.6, WBC 5,400, Plt 131K) and fully resolved by 2026-05-04. The underlying etiology was identified as AML with myelodysplasia-related gene mutations through bone marrow biopsy, flow cytometry, and molecular testing. Treatment with Azacitidine + Venetoclax was started in late 2025, with complete hematologic recovery of all three cell lines by Cycle 4.
Follow-up
- Bone marrow aspiration / flow cytometry report needed
- ~~Copper levels~~ — Resolved: 124.5 ug/dL (normal). See Copper Serum
- Serial CBC monitoring ongoing
Updated automatically during ingest.