Reduction in all three blood lineages (Hb, WBC, platelets).
Etiology
- • Marrow failure (aplastic, MDS)
- • Infiltration (leukaemia, lymphoma, TB, fibrosis)
- • Megaloblastic anaemia, hypersplenism, SLE
- • Drugs (chemo, methotrexate, chloramphenicol)
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Neutropenic fever
- • Bleeding with platelets <20
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, reticulocytes, smear
- • B12/folate, LFT, HIV, viral hepatitis
- • Bone marrow aspirate + biopsy
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Haematology urgent
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
