What you should know about pancytopenia
Pancytopenia is usually due to a problem with the bone marrow that produces the blood cells. However, there can be several different underlying causes.
The condition is not a disease, but a description of the laboratory findings of low blood cells.
- There are many different symptoms and degrees of severity of pancytopenia.
- Sometimes pancytopenia can lead to symptoms that may be life-threatening.
- According to St. Jude Children's Research Hospital, the cause of 50 percent of cases is unknown.
- Most treatments depend on trying to find the underlying cause.
What are the main symptoms of pancytopenia?
Pancytopenia is characterized by a low count of all three types of blood cells.
It is necessary to understand what each of the three different types of blood cells do to recognize pancytopenia's symptoms.
For example, red blood cells carry oxygen. Therefore, if a person does not have enough red blood cells due to pancytopenia, they may have difficulty breathing and feel fatigued.
Platelets are responsible for helping blood to clot, during wound healing. If a person's platelets are low, they may bleed more easily.
White blood cells help to fight infection. Therefore, if a person has a low white blood cell count, they may be more prone to infection.
Additional symptoms associated with pancytopenia include:
- easy bleeding, such as from gums or nose
- easy bruising
- fast heart rate
- pale skin color
- unexplained fatigue
A person should go or be taken to the emergency room immediately if they have the following symptoms, all of which can occur suddenly:
- loss of consciousness
- shortness of breath
- significant blood loss
Conditions that affect the bone marrow, including cancer, may cause pancytopenia.
Pancytopenia is usually due to some disruption of the bone marrow's ability to produce new blood cells. Examples could include:
- cancer that destroys the bone marrow cells
- failure to make stem cells that turn into blood cells
- fibrosis or scarring of bone marrow cells
- immune system destroying healthy bone marrow cells
- suppression of bone marrow function due to illness or medications
Some of the conditions that can cause pancytopenia include:
- aplastic anemia
- autoimmune conditions
- chemotherapy treatments
- exposure to toxins or pollutants, such as radiation or arsenic
- Fanconi's anemia
- leukemia, which impacts bone marrow function
- megaloblastic anemia
- deficiency of folate or vitamin B12 for making bone marrow
- taking medications that affect bone marrow function
- viruses, such as Epstein-Barr, HIV or hepatitis C
Medications that can affect bone marrow function include chloramphenicol, chemotherapy drugs, thiazide diuretics, anti-epileptic drugs, colchicine, azathioprine, and non-steroidal anti-inflammatory drugs (NSAIDs).
The list here covers just some of the potential disease-related pancytopenia causes.
Who is at risk?
Those with cancers or who are taking medications associated with pancytopenia are at risk for the condition. Having a family history of blood disorders or pancytopenia also increases someone's risk.
If a person has a known blood-related disorder, they should talk to their doctor about risks for and symptoms associated with pancytopenia.
Ultimately, a person needs their blood cells to live. If a person does not produce enough blood cells and experiences severe symptoms or infection, it is possible that they could die.
Therefore, it is important that someone seeks immediate medical attention if they are having severe pancytopenia symptoms, such as shortness of breath, high fevers, or severe bleeding.
Blood transfusions may be recommended as a treatment option.
A doctor may order a transfusion of red blood cells or platelets if a person's blood counts are extremely low or they are displaying severe symptoms associated with pancytopenia. Other treatments can include:
- bone marrow transplant
- stem cell transplant
In the case of medications, these may be to stimulate bone marrow production or suppress the immune system if it is impairing bone marrow production.
Because there are so many different pancytopenia causes, the treatments vary widely from person to person.
In some instances, a doctor will expect pancytopenia to develop. This is true when a person has cancer and is undergoing chemotherapy treatments to kill cancer cells.
These treatments can also kill healthy cell types. When a doctor expects this to happen, they may not treat pancytopenia unless the person has significant symptoms.
A doctor will typically diagnose pancytopenia by ordering what is known as a complete blood count or CBC. This blood test gives values of red blood cells, white blood cells, and platelets.
As well as laboratory testing, a doctor will also consider a person's symptoms related to pancytopenia.
They may perform a procedure to sample a person's bone marrow. A sample of bone marrow is commonly taken from the hip after the area has been numbed.
The sample is sent to a laboratory where a doctor will examine the cells under a microscope. The cells' appearances can help identify the potential underlying cause of pancytopenia.
Most pancytopenia causes are underlying blood disorders that a person cannot prevent.
In some cases, avoiding taking medications that are known to cause pancytopenia may help to reduce a person's risk.
However, no one should stop taking a prescribed medication without the express direction of their doctor.