Approach to Pancytopenia in a Deployed Service Member

Area of Science:

• Hematology
• Internal Medicine
• Autoimmune Disorders

Background:

• Pancytopenia results from decreased bone marrow production or increased destruction of cells.
• Pernicious anemia, an autoimmune disorder, typically causes macrocytic anemia due to vitamin B12 deficiency.
• Pancytopenia is an uncommon presentation of pernicious anemia, particularly with hemolysis.

Purpose of the Study:

• To highlight the importance of vitamin B12 deficiency testing in patients with pancytopenia.
• To emphasize the diagnostic challenges in deployed settings.
• To advocate for predeployment screening in individuals with autoimmune conditions.

Main Methods:

• Case presentation of a 24-year-old female with Hashimoto thyroiditis presenting with pancytopenia and hemolysis during deployment.
• Clinical assessment including vital signs, laboratory tests for hemolysis and cytopenia.
• Diagnostic workup for vitamin B12 deficiency and other causes of pancytopenia.

Main Results:

• The patient presented with pancytopenia, hemolysis, and transfusion dependence.
• Initial presentation included hypotension, tachycardia, and fever, improving with transfusions.
• Persistent cytopenia raised concerns for aplastic anemia or acute leukemia, underscoring the need for specific diagnostic testing.

Conclusions:

• Vitamin B12 deficiency testing is crucial for diagnosing or excluding pernicious anemia in symptomatic pancytopenic patients.
• Prompt diagnosis conserves resources by preventing extensive workups and medical escalations.
• Predeployment screening for vitamin B12 deficiency may be beneficial for individuals with a history of autoimmune disorders.