Case Report: Pancytopenia puzzle

An elderly patient presents with a number of differential diagnoses and treatment options.

I was asked to see Joan, an 84-year-old who had been sent in with symptomatic anaemia. She was in fact pancytopenic (Hb 54g/L; WCC 1.4×109/L and platelets 54×109/L).

History
Joan’s history was of being diagnosed with myeloproliferative disease (essential thrombocythaemia +/- polycythaemia) at a big city hospital some five years ago and sent back to this regional area on hydroxyurea, 1g daily. She was later transferred to a residential aged care facility, so

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