### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hi Dr Oana,My mother 86 years old has now pancytopenia (wbc:400, Hb:6.5, Plt:45000) with nearly normal blood biochemistry. 20 days ago she had completely a normal check-up testing (wbc:6000, Hb:11, Plt:170000). About 3 weeks ago she consumed Montelukast/Theophyllin/Seretide/Fexofenadin/Azithromycin (250mg/d/6d)/Gentamycin (80mg/12h/2d)/Betamethasone LA IM for her frequent coughs and moderate obstructive lung disease. She had low grade fever 37-38C during this time. Cefixime 400mg/d were given as her fever didnt stop. We promptly hospitalized her After we noted she has pancytopenia from CBC testing. She is receiving Cefipime now, and will go for BM studies.She had a long history of anemia for 7 years (had been told refractory anemia Hb 10-12 each time testing). The result of her bone marrow aspiration 7 yrs ago was consistent with magaloblastic anemia (normocellular bone marrow with megaloblastic changes).Now, I want to know, in your opinion, what is the sudden underlying cause of her pancytopenia during this 3-weeks while she was clinically and paraclinically ok before that. How do you see her outcome and prognosis, and what tratment do you recommend.

### output:

Hi, dear. I have gone through your question.  I can understand your concern. She has sudden onset pancytopenia. Many causes of pancytopenia are there.  Even viral infection can lead to sudden onset pancytopenia.  Maybe her megaloblastic anemia is responsible for pancytopenia, or she may have other cause.  Best thing to be done is gone for bone marrow examination once. It will clear the picture and all doubt. So go for it and then take treatment accordingly. Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using Chat Doctor. Wish you a very good health.