Pancytopenia - Causes, Symptoms, and Treatment

Introduction:

Pancytopenia is a condition in which the number of red and white blood cells and platelets reduces. When there is a problem with the stem cells in the bone marrow responsible for blood formation, it leads to the development of pancytopenia.

What Is Pancytopenia?

Pancytopenia is a condition in which an individual's body has very few red blood cells, white blood cells, and platelets. Each of these blood cells has a different role in the body:

• Red Blood cells- These are the cells that transmit oxygen throughout the body.

• White Blood Cells - These cells form an essential part of the immune system and fight against infections.

• Platelets - They help in developing clots at the time of any accident or injury.

If a person has pancytopenia, then there exists a combination of three different blood diseases:

• Anemia - Low level of red blood cells.

• Leukopenia - Low level of white blood cells.

• Thrombocytopenia - Low platelet levels.

The body needs all these blood cells, and pancytopenia can be serious. It can even be a severe and life-threatening disease if left untreated for longer.

What Are the Symptoms of Pancytopenia?

Mild pancytopenia often does not cause symptoms. The doctor might find it while doing a blood test for another reason. In the case of severe pancytopenia, the symptoms seen include:

• Shortness of breath.

• Pale skin.

• Fatigue.

• Weakness.

• Fever.

• Dizziness.

• Easy bruising.

• Bleeding.

• Small purple spots on the skin are known as petechiae.

• More prominent purple spots on the skin are known as purpura.

• Bleeding gums and nosebleeds.

• Faster heart rate.

If the following severe symptoms are seen, get medical care immediately:

• Fever over 101˚F (38.3˚C).

• Seizures.

• Heavy bleeding.

• Severe shortness of breath.

• Confusion.

• Loss of consciousness.

What Are the Causes of Pancytopenia?

There is no definitive cause of pancytopenia or it cannot be determined in most of the cases, this is known as idiopathic pancytopenia. While in some cases pancytopenia is caused because of an issue within the bone marrow. This is the tissue inside the bone where blood cells are produced. Pre-existing diseases or exposure to some drugs and chemicals can destroy the bone marrow.

People are more prone to develop pancytopenia if they have one of the following conditions:

1. Cancers that can affect the bone marrow include:

   1. Leukemia.

   2. Multiple myeloma.

   3. Hodgkin's or non-Hodgkin's lymphoma.

   4. Myelodysplastic syndromes.

   5. Megaloblastic anemia is characterized by a reduction in red blood cells and the presence of immature red blood cells produced in the body.

   6. Aplastic anemia (a condition in which the body quits to make sufficient new blood cells).

   7. Paroxysmal nocturnal hemoglobinuria is a blood disorder that destroys red blood cells.

2. Viral infections, such as:

   1. Epstein-Barr virus, which causes mononucleosis.

   2. Cytomegalovirus.

   3. HIV.

   4. Hepatitis.

   5. Malaria.

   6. Sepsis (a blood infection).

3. Diseases that cause damage to bone marrow, such as Gaucher disease.

4. Damage caused due to chemotherapy or radiation treatments for cancer.

5. Exposure to environmental chemicals, such as radiation, arsenic, or benzene.

6. Bone marrow disorders are seen across families.

7. Vitamin deficiencies, such as lack of vitamin B-12.

8. Enlargement of the spleen, known as splenomegaly.

9. Liver disease.

10. Excess alcohol use damages the liver.

11. Autoimmune diseases, such as systemic lupus erythematosus.

What Are the Complications of Pancytopenia?

The complications arise from insufficient red blood cells, white blood cells, and platelets. These include:

• Excess bleeding if platelets are affected.

• Increased risk for infections if white blood cells are affected.

• Severe pancytopenia can be life-threatening.

How Is Pancytopenia Diagnosed?

If the doctors suspect pancytopenia, they will most probably recommend -

• Hematologist: a specialist who treats blood diseases. This specialist investigates the family history and personal medical history. During the exam, the doctor also asks about the symptoms and checks the ears, nose, throat, mouth, and skin. Other tests include:

• Complete Blood Count (CBC): It aids in assessing the number of red blood cells, white blood cells, and platelets in the bloodstream.

• Aspiration and Biopsy- To look for a problem with the bone marrow, the doctor will do a bone marrow aspiration and biopsy. In this test, the doctor uses a needle to remove a small amount of liquid and tissue from the bone, which can be examined in a lab.

• Blood Test: The doctor might also suggest tests to diagnose the cause of pancytopenia via a blood test to check for infections.

• CT Scans or other Imaging Tests- are done to check for cancer or other problems with the organs.

• To check for vitamin B12 and folate levels.

• To test for liver function by LFT (liver function test).

• Tests for checking infectious diseases.

• A test for checking thyroid function.

How Is Pancytopenia Treated?

The doctor treats the underlying condition that caused pancytopenia. This might include stopping medicine or exposure to a particular chemical. If the immune system is harmed, a medication is prescribed to dampen the body's immune response.

Other treatments for pancytopenia include:

• Drugs - They stimulate blood cell production inside the bone marrow.

• Blood transfusion- Replaces red blood cells, white blood cells, and platelets.

• Antibiotics - For the treatment of an infection.

• A stem cell transplant, commonly referred to as a bone marrow transplant, involves the replacement of damaged bone marrow with healthy stem cells that facilitate the regeneration of bone marrow.

How Is Prevention of Pancytopenia Possible?

A few reasons for pancytopenia, such as cancer or inherited bone marrow diseases, cannot be prevented. It is possible to prevent a few infections by maintaining good hygiene practices and avoiding contact with anyone ill. Chemicals should also be avoided that are known to cause this disease.

Conclusion:

Pancytopenia is not classified as a disease but rather as a condition resulting from an abnormality in the bone marrow, which causes decreased levels of red and white blood cells and platelets. The bone marrow serves as the site for the production and maturation of all blood cells. The reason for pancytopenia is nutritional deficiencies, autoimmune diseases, certain viruses, etc. The symptoms include shortness of breath, fatigue, loss of consciousness, etc. It can be diagnosed by CT scans, complete blood count, etc. It can be treated by discontinuing the causative agent or treating the underlying disease. Antibiotics can be used for infections, and blood transfusion is recommended in case of a considerable decrease in blood cells.