Pancytopenia is a laboratory finding rather than a disease. It means a person has fewer platelets, red blood cells, and white blood cells than usual. The workup can include a complete blood count and other tests.
Bone marrow issues can lead to pancytopenia. Bone marrow is a spongy tissue within the bones that contains stem cells, immature cells that can turn into blood cells. A problem with stem cells can mean fewer blood cells enter the bloodstream.
Nutritional deficiencies, autoimmune diseases, certain viruses or toxins, and cancer treatments can also cause pancytopenia.
This article explains what pancytopenia is in more detail, including its symptoms, causes, diagnosis, and treatment.
Pancytopenia is the medical term for when someone has a low amount of red blood cells, white blood cells, and platelets in their blood. It is not a disease but a laboratory indication that doctors measure using a blood test.
Doctors determine that a person has pancytopenia if their blood has:
- less than
11.5 grams per deciliter (g/dl)of hemoglobin in females or less than 13.5 g/dl in males
- fewer than 150,000 platelets per microliter (mcl)
- fewer than 4,000 leukocytes per milliliter (ml) or an absolute neutrophil count of fewer than 1,500–1,800 per ml
If someone has pancytopenia, it means there is an underlying condition causing it. Any conditions that decrease blood cell production or increase blood cell destruction may cause pancytopenia.
Mild pancytopenia may not cause any noticeable symptoms. However, if a person does have symptoms or more severe pancytopenia, it may cause
For example, red blood cells carry oxygen. If an individual has low levels of red blood cells, or anemia, they may experience:
- shortness of breath
- tiredness or fatigue
- chest pain
Platelets help blood clot when someone bleeds. A reduced platelet count is known as thrombocytopenia, with symptoms that may include bruising, bleeding more easily, or difficulty stopping bleeding after an injury.
White blood cells help fight infection. If a person has a low white blood cell count, or leukopenia, they are more likely to develop infections. People with low levels of neutrophils — a specific type of white blood cell — may have serious infections.
Additional symptoms associated with pancytopenia include:
- an enlarged spleen
- fast heart rate
- paler skin than usual
- swollen lymph nodes
Additionally, a person needs immediate medical attention if they have the following symptoms, which may occur suddenly:
- loss of consciousness
- shortness of breath
- significant blood loss
The causes of pancytopenia fall into
The second type is peripheral, meaning a medical condition is causing the destruction of existing blood cells. Sometimes, both causes are involved.
Nutritional deficiencies are the most common cause of central pancytopenia — the body needs nutrients, such as folate and vitamin B12, to make blood cells.
If a person does not get enough nutrition from their diet, they may develop pancytopenia. Alcoholism, malabsorption, tapeworm infections, and certain drugs can also make it hard for the body to absorb nutrients.
Another cause is bone marrow failure, known as aplastic anemia. This condition can occur due to:
- certain viral infections, such as the Epstein-Barr virus, HIV, hepatitis C, or parvovirus B19, which causes fifth disease in children
- bone marrow cell-destroying cancers, such as lymphoma, leukemia, and multiple myeloma
- chemotherapy treatments, including methotrexate, carbamazepine, and chloramphenicol
- certain medications, such as
- toxicity from drugs or chemotherapy agents
- inherited conditions, such as Fanconi’s anemia
Sometimes, aplastic anemia is idiopathic, meaning it has no identifiable cause.
Autoimmune conditions can cause the destruction of blood cells, which occurs when the immune system mistakenly attacks healthy tissues and cells. Examples include rheumatoid arthritis and systemic lupus.
Another cause of pancytopenia is splenic sequestration, where large volumes of blood suddenly pool and become trapped in the spleen. It may occur due to alcoholic liver cirrhosis, HIV, tuberculosis, or malaria.
Individuals with any of the above underlying conditions are at a higher risk for developing pancytopenia. A family history of pancytopenia, cancer, or immunodeficiencies may also increase the risk of developing this issue.
Doctors can diagnose pancytopenia with a complete blood count (CBC), a type of blood test that measures the levels of each blood cell type.
Healthcare professionals may also make a peripheral blood smear by placing some blood on a slide and examining it under a microscope.
Additionally, further tests may be necessary to find the underlying cause for pancytopenia. Such tests include:
- nutritional deficiency tests
- tests for HIV, hepatitis C, or other viruses
- tests for autoimmunity
It may also be necessary to perform a bone marrow aspiration and biopsy, which involves taking a sample of bone marrow, often from the hip, and sending it to a laboratory. From there, a medical professional can assess the bone marrow to check how it is functioning.
Bone marrow aspiration helps doctors diagnose the cause of pancytopenia in
Treatment depends on the underlying cause of the pancytopenia. It may involve:
- correcting nutritional deficiencies
- discontinuing drugs
- treating infections, such as HIV or tuberculosis
- managing autoimmune conditions
- treating cancers
- transplanting bone marrow
- transplanting stem cells
- taking medications
A doctor may also order a transfusion of red blood cells or platelets if a person’s blood counts are extremely low or they display severe symptoms associated with pancytopenia.
If an individual has extremely low white cell counts, doctors may begin broad-spectrum antibiotic therapy to help decrease the risk of infection. They recommend this course of treatment for people with an absolute neutrophil count of
Doctors may also use medications to stimulate bone marrow production or suppress the immune system if it impairs bone marrow production.
In some instances, healthcare professionals may expect pancytopenia to develop. For example, it may occur when a person has cancer and is undergoing chemotherapy treatments, which can also kill healthy cell types. When a doctor expects this, they may not treat pancytopenia unless the individual has significant symptoms.
A person needs sufficient levels of blood cells to live and fight infections. Individuals who do not produce enough blood cells could experience severe symptoms, which can lead to life threatening complications, including:
- an increased risk of infections
- severe, life threatening anemia
Anyone with a fever will require broad-spectrum antibiotics and antifungals, with further tests to determine what germs are causing the infection.
Individuals with severe anemia may need supportive transfusions with packed red blood cells and platelets.
Other complications include tumor lysis syndrome, a metabolic disturbance. It occurs in people receiving chemotherapy for high-grade lymphoma and acute leukemia cancers. If chemotherapy causes the issue, doctors can reverse the pancytopenia by discontinuing the therapy.
If viral infections cause pancytopenia, individuals have a good outlook and often do not require any further treatment.
An individual’s outlook
If the issue is due to a viral infection or nutritional deficiency, pancytopenia may disappear when the virus resolves or a person addresses the deficiency through diet or supplements.
The outlook for pancytopenia from malignant cancers depends on the degree of pancytopenia and the number of healthy stem cells in their bone marrow. If someone’s treatment involves chemotherapy or drugs that cause pancytopenia, their doctor may recommend changing or discontinuing the treatment.
Pancytopenia involves a reduction in the number of red blood cells, white blood cells, and platelets in the blood. It can occur if the bone marrow stops producing as many blood cells as usual or if another condition causes the destruction of blood cells.
Most cases of pancytopenia are minor and
Anyone with symptoms that could indicate pancytopenia should speak with a doctor. Additionally, seek emergency help for severe symptoms, such as loss of consciousness, confusion, and severe bleeding.