๐Ÿฉธ Chapter 518 ยท Acquired Pancytopenias

Nelson Textbook of Pediatrics 22nd Edition | Acquired pancytopenia: aplastic anemia (idiopathic, drug-induced, viral), immune-mediated (seronegative hepatitis, SLE), PNH, MDS, marrow infiltration (leukemia, neuroblastoma). Diagnosis: bone marrow biopsy (hypocellular). Treatment: supportive care, immunosuppression (ATG + cyclosporine), eltrombopag, HSCT (matched sibling donor).

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๐Ÿ“‹ 30 Clinical Scenarios โ€” Acquired Pancytopenias (Aplastic Anemia, MDS)

๐Ÿ“‡ Highโ€‘Yield Review Cards (Acquired Pancytopenias)

๐Ÿฉบ Clinical Recognition: Acquired Pancytopenias

Select a presentation for diagnostic clues and management.

๐Ÿ“‹ Stepwise Management of Acquired Aplastic Anemia

๐Ÿ”‘ Key Principles โ€” Nelson Chapter 518
โ€ข Severe aplastic anemia (SAA): Bone marrow cellularity <25% (or <50% with <30% hematopoietic cells) + โ‰ฅ2 of: ANC <500, platelets <20,000, reticulocytes <20,000 (or <1% corrected).
โ€ข First-line with matched sibling donor: HSCT (survival ~90%).
โ€ข No sibling donor: Immunosuppression (horse ATG + cyclosporine) + eltrombopag. Response rate 60-70%.
โ€ข Eltrombopag (TPO agonist): Improves trilineage response in refractory aplastic anemia.
โ€ข Supportive care: Transfusions (irradiated, leukoreduced), infection prophylaxis, growth factors (G-CSF).
โ€ข MDS: Refractory cytopenia of childhood (RCC). HSCT for advanced MDS.

    โšก Reflex Prompts โ€” Clinical Decisions in Acquired Pancytopenias

    ๐Ÿ“– Summary: Acquired Pancytopenias โ€” Nelson Chapter 518