Bone marrow Bx in drug-induced pancytopenia

 Q: 24 years old female is admitted to ICU with severe pancytopenia after 12 weeks course of anti-acne medication. Immediate bone marrow biopsy is indicated.

A) True

B) False

Answer: B

An emergent/immediate bone marrow biopsy is usually of no help in drug induced pancytopenia. Bone marrow may only show aplasia or hypoplasia without any clue towards the cause. Offending/suspected drug needs to be discontinued followed by serial blood counts and clinical observation. 

Bone marrow biopsy in early recovery phase is also not recommended unless an hematologist find it necessary. The biggest caveat of bone marrow biopsy in drug induced pancytopenia is the high erroneous diagnosis of acute leukemia. In this phase bone marrow may show a “maturation arrest” as hematopoiesis has only progressed to an immature stage of maturation.

Hematologist should be consulted to make decision in such a tricky situation.

#hematology

#pharmacology

Reference:

Nancy Berliner: Approach to the adult with pancytopenia - UpToDate; 2021

Link: https://www.uptodate.com/contents/approach-to-the-adult-with-pancytopenia