Pancytopenia

mimij404@gmail.com

Please weigh in on whether you use total leukocytes (WBC count) or absolute neutrophil count (ANC) when evaluating for pancytopenia? Some colleagues have said total WBC count is used and some say ANC <1.5 is used in determining the white cell count element of pancytopenia. Thanks for your help. 
Mimi Jones, BSN, RN, CCDS
Vibra Healthcare

Sharme.Brodie@hcpro.com

The absolute neutrophil count (ANC) is the number of neutrophils (also referred to as Segs, Segmented neutrophils, polys, and the most immature stage called bands or stabs)  you have in a certain amount of blood. Neutrophils are a type of white blood cells (WBC), and very important in fighting fungal and bacterial infections  A low neutrophil count is called neutropenia. The ANC can be calculated by {(% of neutrophils + % of bands) divided by 100} x WBC count = ANC. A ANC count of less than 1,000 or lower is an indicator of a weakened immune system.  There are different types of WBC (leukocytes) including lymphocytes, monocytes, neutrophils, eosinophils, and basophils, with the two most common including lymphocytes and neutrophils. A low WBC count is called leukopenia. Pancytopenia is a condition in which a person's body has too few red blood cells (RBC) anemia, white blood cells (WBC) leukopenia and platelets (also known as thrombocytopenia). Leukopenia is so often caused by a decrease in neutrophils that some use the terms "leukopenia" and "neutropenia" interchangeably. it is possible for a patient to have WBC count within normal range, while their neutrophil count is low. But because neutrophils normally make up the largest part of the total white blood cell count, the WBC count is usually low when the neutrophil count is low. Pancytopenia starts because of a problem with the bone marrow, the spongy tissue inside of the bones, where the cells are produced, this can be caused by a variety of conditions including disease or exposure to certain chemicals or drugs. I would recommend having a conversation with a Hematologist at your facility and see what they have to say. hopefully this information is helpful

evanspx@sutterhealth.org

I use total WBC, along with the other elements that may support a diagnosis of Pancytopenia.  I am mindful of any impact of hemodilution.  I check H&P to see if intrinsiic causes that impact erhtropoesis may be a factor versus extrinsic causes, such as Chemotherapy or immunotherapy.  A ‘good number’ of our patients admitted for chemotherpay or immunotherapy demonstrate abrupt decline in all 3 elemments after initiation of chemo or immunotherapy 

P. Evans, RHIA