Transplant Infectious Disease Evaluation of Cytopenias
Cytopenias are a common occurrence in both hematopoietic stem cell and solid organ transplant recipients, particularly in the early post-transplant time period. The etiology is frequently multifactorial, reflecting the simultaneous interplay of infection, immunologic derangements, and medication effects in this patient population. These factors continually change over time, further adding to the complexity of diagnosis and management. Thorough evaluation of the individual’s medical history, physical exam, and preliminary laboratory values can assist with prioritizing the differential diagnosis and focusing the diagnostic workup. While absolute cytopenia cutoff values to trigger urgent intervention are variably defined and patient-specific, it is important to recognize those conditions that are life-threatening in order to initiate prompt and aggressive interventions. In less urgent clinical situations, a more methodical approach to diagnosis and treatment is favored, often beginning with modification of immunosuppressive and/or other medications. In most instances, optimal management of transplant-associated cytopenias requires a multidisciplinary approach. This chapter discusses the range of etiologies of transplant-associated cytopenias, followed by a general approach to diagnosis and management.
