Pancytopenia: symptoms, causes and treatment

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Pancytopenia is a descriptive term for a combination of low levels of all types of blood cells, including red blood cells ( anemia ), white blood cells (leukopenia), and platelets ( thrombocytopenia ). Symptoms that often result from a decrease in the level of these cells include fatigue, infections, and bruising.

There are several different conditions that can cause pancytopenia, including bone marrow disorders, some cancers, and some infections; Chemotherapy treatment can also cause pancytopenia. Treatment options for pancytopenia depend on the specific cause and generally focus on raising cell levels to improve symptoms while treating the underlying cause.

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Blood cells affected by pancytopenia

Pancytopenia refers to a deficiency of the three main types of blood cells. In particular, these include:

  • Red blood cells (erythrocytes) : Red blood cells are cells that stick together and carry oxygen to the tissues of the body.
  • Leukocytes (leukocytes) : There are several types of leukocytes, which are broken down into granulocytes (including neutrophils , eosinophils, and basophils) and agranulocytes (including lymphocytes and monocytes). These cells, among other functions, are responsible for fighting infections.
  • Platelets : Platelets are responsible for blood clotting.

Description of low blood cell count

These terms are used for lower levels of blood cells:

  • A low red blood cell count is called anemia .
  • A low white blood cell count is called leukopenia (you may hear about neutropenia , which refers to a low count of a certain type of white blood cell known as neutrophils).
  • A low platelet count is called thrombocytopenia , such as immune thrombocytopenia and chemotherapy-induced thrombocytopenia.

Blood cell formation in the bone marrow or hematopoiesis.

All blood cells originate from a common cell type in the bone marrow known as hematopoietic stem cells (HSM) or pluripotent stem cells (meaning they have the "potential" to grow into many different cell types). These cells divide and, through a process called hematopoiesis, increasingly specialize in all the blood cells in the body.

Lab tests

Pancytopenia is usually diagnosed based on a complete blood count.

In pancytopenia, a CBC will show insufficient levels of all types of blood cells, including:

  • Red blood cell counts are less than 4.2 million cells per microliter (μL) in women and less than 4.7 million cells per μL in men (this can also be described by low hemoglobin levels).
  • The number of leukocytes is less than 4,000 cells / μl (typically 4,000 to 10,000 cells / μl).
  • The platelet count is less than 150,000 cells / microliter (the normal range is 150,000 to 400,000 cells / microliter).

Causes

Pancytopenia can be caused by anything that interferes with the formation of blood cells in the bone marrow or the availability of blood cells in the bloodstream (for example, if the cells are retained in the spleen).

This can include destruction of the bone marrow by toxins, suppression of the bone marrow (during chemotherapy), or replacement of the bone marrow with other cells, leading to disruption of blood cell production, as can happen. with some cancers. Destruction or suppression of blood cells can occur due to inflammation, infection, or autoimmune conditions.

Most of these conditions are acquired later in life, but some are inherited and present from birth.

Some of the possible causes of pancytopenia include:

  • Chemotherapy-induced bone marrow suppression
  • Suppression by drugs other than chemotherapy, from antibiotics to drugs for heart disease
  • Infections such as infectious mononucleosis, HIV, and sepsis.
  • Aplastic anemia
  • Spleen sequestration (keeping blood cells in the spleen so they cannot reach the rest of the body)
  • Toxins and chemical attack such as arsenic or benzene
  • Cancer of the blood in the bone marrow, such as leukemia, lymphoma, myeloma, or metastatic cancer in the bone marrow.
  • Spread of certain solid tumors to the bone marrow, especially breast cancer, prostate cancer, colon cancer, stomach cancer, and melanoma, generally causing anemia followed by thrombocytopenia.
  • Myelodysplastic syndromes ("precancerous" conditions of the bone marrow)
  • Autoimmune diseases like lupus.
  • Radiation sickness
  • Hereditary syndromes such as Fanconi anemia and Diamond Blackfan anemia.

Most common reasons

In a 2016 study, 70 patients with pancytopenia participated. Among these patients, the most common causes were:

  • Megaloblastic anemia: 41.4% of cases
  • Aplastic anemia: 22.9%
  • Hypersplenism (overactive spleen): 15.7%
  • Leukemia: 14.2%

Together, these four causes accounted for 94.3% of the cases.

Symptoms

Symptoms of pancytopenia can include a weak or enlarged spleen in addition to symptoms associated with a deficiency of certain blood cells. Some of these symptoms include.

  • Symptoms associated with anemia (low red blood cell count) include fatigue, heart palpitations, and shortness of breath.
  • Symptoms associated with leukopenia or neutropenia (low whitening): fever and signs of infection such as cough or painful urination.
  • Symptoms associated with thrombocytopenia (low platelet count) include easy bruising and heavy bleeding.

Diagnosis and evaluation

Pancytopenia can be seen on a complete blood count (CBC). The first step in evaluating the low levels of all cells is to repeat the CBC. A peripheral blood smear is then taken to examine each of the different types of cells. If you happen to have pancytopenia, the next step is usually a bone marrow biopsy.

Bone marrow aspiration and biopsy examines the components of the bone marrow, including hematopoietic stem cells (cells that differentiate into all different types of blood cells), blood cells at different stages of maturation, and materials used to make blood cells. as iron and vitamin B12.

In addition to examining the level of B12 in the blood, special tests and stains are performed on the cells to detect changes, such as chromosomal and genetic changes, that are often found in leukemia.

Watch out

The goal of treating pancytopenia is to find and eliminate the root cause. If the cause is unknown or pancytopenia is expected, as with chemotherapy, treatment aims to minimize symptoms associated with a blood cell deficiency. Some of the treatments that can be used include:

  • Bone Marrow Stimulating Drugs: For chemotherapy-induced neutropenia and some other causes, growth factors leucine, neupogen, or neelasta can be used to stimulate white blood cell production. Various drugs may also be considered for chemotherapy-induced anemia.
  • Blood transfusion
  • Immunosuppressants, if the cause is associated with an autoimmune disease.
  • Bone marrow transplant or stem cell transplant

Forecast

The prognosis for pancytopenia depends largely on its cause. Fortunately, we now have therapies like blood transfusions and stimulants to help with certain blood cell deficiencies while the underlying condition is evaluated and treated.

Get the word of drug information

There are many potential causes of pancytopenia, but they all carry risks. In pancytopenia, all types of blood cells decrease, although a decrease in some may be more worrisome than in others.

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