Pancytopenia: When All Your Blood Cells Decrease

Myelofibrosis, infections, and more can be a cause

Studio shot of blood sample
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Pancytopenia refers to a decrease in all three blood cells at the same time: white blood cells (leukopenia), red blood cells (anemia) and platelets (thrombocytopenia). If only two blood cells are decreased, it is called a bicytopenia.

What Are the Symptoms of Pancytopenia?

  • Fatigue or tiredness
  • Pallor (pale skin)
  • Increased bruising
  • Small red dots on the skin known as petechiae
  • Excessive bleeding: nose, mouth, urine, stool, etc.
  • Fever
  • Recurrent infections
  • Mouth sores

What Causes Pancytopenia?

The causes of pancytopenia are broad. Sometimes the cause is never identified. This is called idiopathic pancytopenia. Below is a list of some of the causes; there are many more.

  • Aplastic Anemia: This is an acquired syndrome where the immune system prevents blood cell production in the bone marrow.
  • Bone Marrow Failure syndrome: These inherited conditions prevents the bone marrow from producing the blood cells. These include Fanconi Anemia, Shwachman Diamond Syndrome, or Dykeratosis Congenita.
  • Myelodysplastic syndrome (MDS): MDS is a blood cancer that prevents blood cells from being developed normally.
  • Cancer: Leukemia, in particular, affects the blood cells and may present with pancytopenia.
  • Myelofibrosis: Scarring in the bone marrow prevents blood cells from forming properly.
  • Chemotherapy: Chemotherapy used to treat cancer temporarily suppresses the production of blood cells.
  • Medications: Antibiotics and immunosuppressive medications like those given after organ transplantation are common culprits.
  • Infections: Viral infections are well known for causing temporary suppression of blood cell production. Human Immunodeficiency Virus (HIV) and Ebstein Barr Virus (EBV) are well-known causes.

    How Is Pancytopenia Diagnosed?

    Pancytopenia, likely many blood disorders, is initially identified on complete blood count (CBC). Because pancytopenia can be temporary in some people, your physician may just observe you and repeat CBCs to see if the pancytopenia is resolving.

    If pancytopenia persists, your primary physician will likely refer you to a hematologist, a physician specializing in blood disorders. Testing is used to try to identify the cause of the low blood cell counts.  Identifying the cause is important as it affects what treatment is used. In general, most patients with pancytopenia undergo a bone marrow aspirate and biopsy to assess the are where the blood cells source of the blood cells for issues.

    How Is Pancytopenia Treated?  

    The treatment chose for pancytopenia is determined by the cause.

    • Observation: If pancytopenia is thought to be secondary to viral suppression, your physician may simply observe you with repeated CBCs to see if it will resolve.
    • Medication cessation: If the pancytopenia is thought to be caused by a medication, it may be discontinued. Sometimes, if the pancytopenia is mild and the medication is considered essential, the medication will be continued and your blood counts will be monitored.
    • Transfusions: Red blood cell and platelet transfusion may be used to prevent symptoms of anemia and thrombocytopenia.
    • Immunosuppressive therapy: These medications are used primarily for treatment of aplastic anemia to reset the immune system.
    • Chemotherapy: Chemotherapy can be used to treat cancer or MDS that causes pancytopenia.
    • Bone marrow stimulation medications: Medications that can stimulate the production of red blood cells to reduce the number of transfusions or white blood cells to prevent infections may be used.
    • Bone marrow transplant: In severe conditions like certain cancers, myelodysplastic syndrome, or myelofibrosis bone marrow transplantation may be the best long-term therapy.  Stem cells from a donor (preferably whose genetics closely match) are infused into the recipient's stem cells engraft into the bone marrow, they produce normal blood cells.

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