233. Marrow’s Most Wanted- An Approach to Pancytopenia

Pancytopenia is a critical clinical manifestation characterized by a simultaneous decrease in hemoglobin, platelets, and white blood cells, originating from bone marrow failure, infiltration, or peripheral destruction. Effective management begins with stabilizing the patient against life-threatening risks like febrile neutropenia or hemorrhage, followed by a systematic investigation of potential etiologies including malignancy, nutritional deficiencies, and drug toxicities. Diagnostic clarity often requires a peripheral blood smear to identify pathognomonic clues such as hypersegmented neutrophils or dacryocytes, with bone marrow biopsy reserved for unresolved cases. Emerging treatments for underlying causes like myelodysplastic syndrome (MDS) now include luspatercept, which has demonstrated superior transfusion independence in clinical trials compared to traditional erythropoiesis-stimulating agents. Targeted interventions, ranging from vitamin replacement to chemotherapy or stem cell transplants, remain the cornerstone of resolving the underlying marrow dysfunction.