Table 2.

Clinical evaluation of the cytopenic patient

Clinical historyFeatures, severity and duration of cytopenia
  • Symptoms of anaemia (eg breathlessness, fatigue)

  • Symptoms of neutropenia (ie infection)

  • Symptoms of thrombocytopenia (ie bleeding history, rash)

Any history of recent transfusions
Any infections – particularly viral
Autoimmune disease – joint, eye, skin symptoms
Constitutional symptoms suggestive of underlying lymphoproliferative disease (fevers, night sweats, weight loss)
Drug history including herbal medicines
Alcohol history
Family history
ExaminationFeatures of anaemia (eg pallor, flow murmur), neutropenia (skin infection), thrombocytopenia (purpura, mucosal bleeding)
Lymphadenopathy, hepatosplenomegaly
Joint, eye or skin abnormalities
Blood testsFBC and blood film
AIHA: DAT, LDH, reticulocyte count, bilirubin, haptoglobin
Coagulation screen
Viral serology: HIV, Hepatitis B/C, EBV, CMV, Parvovirus
Autoimmune profile
Immunoglobulins / protein electrophoresis
Urine testsPregnancy test
TTP: proteinuria
Bone marrow examinationBone marrow smear, karyotype (consider this if any evidence dysplasia on blood film)
CT imagingConsider to rule out evidence underlying malignancy
  • AIHA = autoimmune haemolytic anaemia; CMV = cytomegalovirus; DAT = direct antiglobulin test; EBV = Ebstein–Barr virus; FBC = full blood count; LDH = lactate dehydrogenase; TTP = thrombotic thrombocytopenia purpura