Approach to Pancytopenia in a Deployed Service Member.

Steven J Gibson, Benjamin Swanson, Carl R Tischbein, Kathleen E Bathon, Karen J Shou, Karen G Zeman
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Abstract

Background: Pancytopenia is a result of increased destruction or decreased production of bone marrow cells and has a broad differential. Pernicious anemia commonly presents as a macrocytic anemia and is typically autoimmune in nature and the result of vitamin B12 deficiency. Pancytopenia is a rare presentation of this disorder especially in the setting of hemolysis. Testing in the deployed setting may be limited and/or challenging.

Case presentation: A 24-year-old female patient with a history of Hashimoto thyroiditis presented during an overseas deployment with a witnessed syncopal episode and was found to be pancytopenic with a mild transaminitis and laboratory tests demonstrating hemolysis. Though initially she was hypotensive, tachycardic, and febrile, her vitals improved after multiple transfusions, but she had persistent cytopenia with transfusion dependence, concerning for aplastic anemia or acute leukemia.

Conclusions: Testing for B12 deficiency is crucial in symptomatic, patients with pancytopenic to either diagnose or exclude pernicious anemia and conserve resources by preventing costly workup and transfer/escalation of medical care, especially in the deployed setting. A predeployment screening in those with history of autoimmune disorders may be warranted.

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现役军人全血细胞减少症的治疗方法。
背景:全血细胞减少症是骨髓细胞破坏增加或生成减少的结果,具有广泛的差异。恶性贫血通常表现为巨细胞性贫血,本质上是典型的自身免疫性贫血,是维生素B12缺乏的结果。全血细胞减少症是这种疾病的一种罕见的表现,特别是在溶血的情况下。在已部署的环境中进行测试可能会受到限制和/或具有挑战性。病例介绍:一名24岁女性患者,有桥本甲状腺炎病史,在海外部署期间出现晕厥发作,发现全细胞减少性伴轻度转氨炎,实验室检查显示溶血。虽然最初她有低血压、心动过速和发热,多次输血后生命体征有所改善,但她有持续性细胞减少并输血依赖,涉及再生障碍性贫血或急性白血病。结论:对有症状的全细胞缺乏症患者进行B12缺乏症检测对于诊断或排除恶性贫血至关重要,并通过避免昂贵的检查和转移/升级医疗护理来节省资源,特别是在部署环境中。对有自身免疫性疾病史的患者进行部署前筛查可能是有必要的。
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