Pancytopenia—Definition, Symptoms, and Treatments

A Combination of Anemia, Leukopenia, and Thrombocytopenia

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What is meant by the term pancytopenia and what are the possible causes?. Hinterhaus Productions/Getty Images

What is pancytopenia, what are the symptoms, what causes it, and how is it treated? Let's take a look at those questions.

Definition: Pancytopenia

Pancytopenia is defined as abnormally low levels of all types of blood cells produced by the bone marrow. This includes red blood cells, white blood cells, and platelets.

Blood Cells Affected in Pancytopenia

Specifically, pancytopenia refers to a deficiency of:

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

Describing Low Levels of Blood Cells

  • A low level of red blood cells is referred to as anemia. It's important to note that there are different forms of anemia. One cause is a low level of red blood cells, but it may also occur due to blood loss, a low level of hemoglobin, a deficiency of vitamin B12, and other causes.
  • A low level of white blood cells is referred to as leukopenia (you may hear of neutropenia, which refers to a low level of the particular type of white blood cells known as neutrophils).

Formation of Blood Cells in the Bone Marrow - Hematopoiesis

Blood cells all originate from a single common cell in the bone marrow known as a hematopoietic stem cell (HSM) or pleuripotential stem cells (meaning that it has the "potential" to become many different types of cells.

These cells divide and become progressively more specialized in a process called hematopoiesis into all of the blood cells in the body.

Lab Tests

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

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

Causes of Pancytopenia

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

This may involve bone marrow destruction by toxins, bone marrow suppression, such as during chemotherapy, or the replacement of bone marrow by other cells resulting in the disruption of blood cell production as can occur with some cancers. Destruction or suppression may 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.

At least 50 percent of the time there is not an obvious cause—something doctors refer to as "idiopathic." Some of the possible causes of pancytopenia may include:

  • Chemotherapy-induced bone marrow suppression.
  • Drug-induced: Drugs other than chemotherapy drugs, from antibiotics to medications used for heart disease, have been cited as causes.
  • Infections such as infectious mononucleosis and HIV, as well as overwhelming infections (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 such as leukemia, lymphoma, myeloma, or metastatic cancer to bone marrow.
  • ​Spread of some solid tumors to the bone marrow, especially breast cancer, prostate cancer, colon cancer, gastric cancer, and melanoma. With bone marrow metastases the most common symptom is anemia followed by thrombocytopenia.
  • Myelodysplastic syndrome (a "pre-cancerous" condition of the bone marrow).
  • Autoimmune disorders such as lupus.
  • Radiation sickness.
  • Inherited syndromes, such as Fanconi anemia, Diamond Blackfan anemia.

Most Common Causes of Pancytopenia

A 2014 study set out to determine the most common causes of pancytopenia in people who were not already diagnosed with a condition. For example, none of these adults had received chemotherapy or had obvious reasons for their pancytopenia. Of these people:

  • Over 60 percent had some type of blood-related cancer. Most common were acute myelogenous leukemia, myelodysplasia, non-Hodgkin's lymphoma, hairy cell leukemia, and acute lymphocytic leukemia.
  • Of those who did not have a blood-related cancer as the cause of their pancytopenia, diagnoses included aplastic anemia, megaloblastic anemia, and HIV. anemia, and HIV.

Symptoms of Pancytopenia

The symptoms of pancytopenia may include weakness, seizures, or an enlarged spleen in addition to symptoms related to deficiency of specific blood cells. Some of these symptoms include:

  • Symptoms related to anemia (a low red blood cell count) including pallor, fatigue, rapid heart rate, and shortness of breath.
  • Symptoms related to a leukopenia or neutropenia (a low white count) including fever and signs of infection such as a cough or pain with urination
  • Symptoms related to thrombocytopenia (low platelets) including easy bruising, and heavy bleeding.

Diagnosis and Evaluation of Pancytopenia

After repeating your lab work to confirm that you truly have pancytopenia, the first step is often a bone marrow biopsy.

A  bone marrow biopsy report can give your doctor a lot of information.

Treatment of Pancytopenia

The goal in treating pancytopenia is to find and treat the underlying cause. If the cause is not known, or if it is expected, such as with chemotherapy, treatment is aimed at minimizing the symptoms related to a deficiency of the blood cells. Some treatments that may be used include:

Prognosis

The prognosis of pancytopenia depends largely upon its cause. Thankfully we now have treatments such as transfusions and stimulating factors to help with the specific blood cell deficiency while the underlying condition is evaluated and treated.

Bottom Line on Pancytopenia

There are many potential causes of pancytopenia, but all carry risks. With pancytopenia all types of blood cells are reduced, although reductions in some may be of more concern than others.

Example: Dan developed pancytopenia—a low level of red blood cells, white blood cells, and platelets—after his last chemotherapy treatment.

Sources:

Devitt, K., Lunde, J., and M. Lewis. New Onset Pancytopenia in Adults: A Review of Underlying Pathologies and Their Associated Clinical and Laboratory Findings. Leukemia and Lymphoma. 2014. 55(5):1099-105.

Miano, M., and C. Dufour. The Diagnosis and Treatment of Aplastic Anemia: A Review. International Journal of Hematology. 2015. 101(6):527-35.

Sharma, R., and G. Nalepa. Evaluation and Management of Chronic Panycytopenia. Pediatrics in Review. 2016. 37(3):101-113.

Weinzierl, E., and D. Arber. Bone Marrow Evaluation in New-onset Pancytopenia. Human Pathology. 2013. 44(6):1154-64.

Weinzierl, E., and D. Arber. The Differential Diagnosis and Bone Marrow Evaluation of New-onset Pancytopenia. American Journal of Clinical Pathology. 2013. 139(1):9-29.

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