An Overview of Pancytopenia

Pancytopenia is a descriptive term referring to the combination of low levels of all of the types of blood cells including red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia). Symptoms, which often occur due to the reduced levels of these cells, include fatigue, infections, and bruising.

In this article, explore the symptoms od pancytopenia as well as causes, diagnosis, and treatment.

What Is Pancytopenia?

Pancytopenia refers to a deficiency in all three major types of blood cells. Specifically, these include:

• Red blood cells (RBCs): RBCs are the cells that bind and carry oxygen to the tissues of the body.
• White blood cells (WBCs): There are several types of WBCs, which are further divided into granulocytes (including neutrophils, eosinophils, and basophils) and agranulocytes (including lymphocytes and monocytes). These cells are responsible for fighting infections, among other functions.
• Platelets: Platelets are responsible for blood clotting.

Describing Low Levels of Blood Cells

These terms are used for lower levels of blood cells:

• Anemia: A low level of red blood cells
• Leukopenia: A low level of white blood cells
• Thrombocytopenia: A low level of platelets is referred to as thrombocytopenia

Symptoms of Pancytopenia

Pancytopenia symptoms may include weakness, an enlarged spleen, and symptoms related to deficiency of specific blood cells. Some of these symptoms include:

• Fever
• Feeling out of breath
• Bone pain
• Weight loss
• Abdominal pain
• Swelling
• Paleness

Causes of Pancytopenia

Pancytopenia may be caused by anything interfering with the formation of blood cells in the bone marrow or blood cell availability in the bloodstream (such as if the cells are held in the spleen).

This may involve bone marrow destruction by toxins, bone marrow suppression (during chemotherapy), or the replacement of bone marrow by other cells, which can disrupt blood cell production, as can occur with some cancers. Blood cell destruction or suppression may also occur from inflammation, infections, or autoimmune conditions.

Most of these conditions are acquired later in life, but a few 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 drugs, from antibiotics to heart disease medications
• Infections, such as infectious mononucleosis, HIV, and sepsis
• Aplastic anemia
• Splenic sequestration (holding of blood cells in the spleen so they can't get to the rest of the body)
• Toxins and chemical exposure, such as exposure to arsenic or benzene
• Blood cancers in the bone marrow, such as leukemia, lymphoma, myeloma, or metastatic cancer to the bone marrow
• Spread of some solid tumors to the bone marrow, especially breast cancer, prostate cancer, colon cancer, gastric cancer, and melanoma, which usually causes anemia followed by thrombocytopenia
• Myelodysplastic syndromes ("pre-cancerous" conditions of the bone marrow)
• Autoimmune disorders, such as lupus
• Radiation sickness
• Inherited syndromes, such as Fanconi anemia and Diamond-Blackfan anemia

Most Common Causes

Some of the most commonly seen causes of pancytopenia include:

• Acute leukemia
• Megaloblastic anemia
• Aplastic anemia
• Hypersplenism
• Multiple myeloma
• Myelodysplastic syndrome
• Infections
• Lymphoma
  

Diagnosing Pancytopenia

Pancytopenia is usually diagnosed by looking at a complete blood count (CBC). In pancytopenia, a CBC will show deficient levels of all types of blood cells, including:

• A red blood cell count of fewer than 4.2 million cells per microliter (ul) in women or less than 4.7 million cells/ul in men (This may also be described by a low hemoglobin level).
• A white blood count of less than 4,000 cells/ul (normal is between 4,000 and 10,000 cells/ul).
• A platelet count of less than 150,000 cells/ul (normal is between 150,000 and 400,000 cells/ul).

If it appears that you have pancytopenia, the next step is often a bone marrow biopsy.

A bone marrow biopsy looks at the components of bone marrow, which include hematopoietic stem cells (the cells that differentiate into all of the different types of blood cells), blood cells in various phases of maturation, and supplies used to make blood cells, such as iron and vitamin B12.

In addition to checking B12 levels in the blood, special stains and tests are performed on the cells to look for changes, such as chromosomal and gene changes, often found with leukemias.

Treatment of Pancytopenia

The goal of treating pancytopenia is to find and treat the underlying cause. If the cause is unknown, or if the pancytopenia is expected, such as chemotherapy, treatment is aimed at minimizing the symptoms related to the deficiency of blood cells. Some treatments that may be used include:

• Drugs that stimulate the bone marrow: For chemotherapy-induced neutropenia and some other causes, the growth factors Leukine, Neupogen, Neulasta, or Ryzneuta may be used to stimulate the formation of WBCs. For chemotherapy-induced anemia, some medications may be considered.
• Blood transfusions
• Immunosuppressive drugs if the cause is due to an autoimmune condition
• Bone marrow transplant or stem cell transplant

Summary

Several different conditions can cause pancytopenia, including bone marrow diseases, some cancers, and some infections; chemotherapy treatment can also cause pancytopenia. The treatment options for pancytopenia depend on the specific causes and usually focus on increasing the levels of cells to improve symptoms while treating the underlying cause.