Introduction:
Blood is the most important part of the human circulatory system. Blood and its components serve various functions in the human body. Blood and its components are integral to the human body, serving functions like circulating oxygen to immunity. Blood is made up of plasma and formed elements. The Plasma is made up of proteins, gases, water, and nutrients. The formed elements are also known as cellular elements. Various cells present in the blood play different functions in the human body. A particular proportion is maintained within the blood cells. However, the proportion within the cells is altered in certain situations, leading to different abnormalities.
What Is Pancytopenis?
Forty-five percent of the blood components are cellular elements. The most common and abundant blood cell is red blood cells. The primary function of red blood cells is to carry gaseous substances from one place to another. The adult human body's cubic millimeter of blood contains 4-6 million cells. However, adult women usually have slightly fewer red blood cells. The other types of blood cells present in the blood are categorized as white blood cells. White blood cells range from 4500 to 11,000 per cubic millimeter of blood. Different kinds of white blood cells are present in the blood, and these are categorized into granulocytes and granulocytes based on the presence of granules inside the cell. Neutrophils, eosinophils, and basophils are categorized as granulocytes. Neutrophils are the most abundant white blood cells in the body. The primary function of these cells is to provide immunity. Monocytes and lymphocytes are agranulocytes and function as immune cells. Other than this, palates are present in the blood and are responsible for blood coagulation and clotting. The number of platelets in the blood is 150,000 to 450,000 per cubic millimeter of blood.
Pancytopenia is a condition of the blood where a decline in all three types of blood cells can be seen. This is a pathological condition but not a diseased condition. In most cases, pancytopenia is caused by other conditions or disorders. In such cases, the total number of white blood cells is less than 4000 per cubic millimeter of blood. The number of platelets in pancytomia is below 150000. The blood's hemoglobin count goes below the normal level in such cases.
What Is Pancytonia in the Elderly?
The reduction in the number of blood cells with increased age is known as pancytopenia in the elderly. The causative factors associated with it are;
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Decreased Production (Central Type): Bone marrow is responsible for the production of newly formed blood cells. The progenitor cell of blood resides in the bone marrow. Failure of the bone marrow to produce newer cells is responsible for central-type pancytopenia. With increasing age, a decline in bone marrow cellularity is observed. Also, the amount of hemopoietic tissue in the bone marrow decreased from 60 percent to 40 percent in elderly people. Other changes seen in the bone marrow hemopoietic cells are the shortening of telomeres and mitochondrial DNA mutations. These changes are also associated with age-related changes. Nutritional deficiency in elderly people may also be associated with the decreased production rate of bone marrow.
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Infectious Conditions: Infections caused by human immunodeficiency virus (HIV), cytomegalovirus, or Epstein-Barr virus. Though such infections may cause bone marrow suppression at any point in life, susceptibility to these infections and complications like bone marrow suppression is seen in elderly people. Decreased immunity is one of the responsible factors for this.
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Bone Marrow Infiltration: Infiltration of the bone marrow by other tissues and cells causes replacement of the bone marrow. Such changes are seen in cancerous conditions like lymphoma (cancer of the lymphatic system), leukemia (blood cancer of blood cells), and multiple myeloma (cancer of the cancer cells). Other than this, granulomatous diseases cause the deposition of fibrous tissues in the bone marrow.
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Increased Destruction: An increased destruction of cells seen in various conditions like auto-immune disorders. Other than this, diseases like alcoholic liver cirrhosis, HIV, tuberculosis, and malaria. Disorders of the spleen are also responsible for such conditions.
In elderly people, nutritional deficiency and infectious conditions are the main causes of pancytopenia. Drug-induced pancytopenia may caused by the administration of immune suppressive drugs or drugs such as Carbamazepine and Chloramphenicol.
What Are the Symptoms of Pancytopenia?
Mild cases of pancytopenia are usually symptomless. However, patients with moderate to severe reduction in the cell population present with the following symptoms;
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Anemia is the most commonly associated symptom in such cases. Patients complain of fatigue, headache, and breathlessness. The whitish appearance of the tongue, depopulation of the tongue, the whitish appearance of the nail bed, and discoloration of skin can be seen.
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An increased susceptibility toward infections indicates a deficiency of white blood cells.
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A deficiency of the platelet count is manifested as bruising, petechiae (small skin spots due to internal bleeding), and a propensity for bleeding from gum.
Other systemic examinations may reveal associated problems based on etiology. Symptoms like enlarged sleep and swelling of the abdomen can be seen due to the involvement of the spleen and liver. Nutritional deficiency and vitamin deficiency cause neurological problems and skin disorders.
For diagnosis, blood cell count and bone marrow aspiration can be evaluated. Other tests of the bone marrow, such as fluorescent in situ hybridization [FISH] and flow cytometry of bone marrow, are useful to evaluate bone marrow changes.
What Are the Treatment Methods?
The treatment of elderly pancytopenia starts with diagnosing the etiology of the condition. Nutritional deficiency can be treated by proper nutrition and vitamin supplements. Vitamin B12 deficiency is one of the most common causes of pancytopenia. In such cases, vitamin B12 supplements can be given. Infectious conditions such as malaria and tuberculosis are treated with the application of antibiotics.
Conclusion:
Pancytopenia in the elderly is characterized by a reduction in all types of blood cells. Nutritional deficiency is the most common causative factor associated with this condition. Apart from this, infectious disorders and malignancy are responsible for such complications. Identification of the exact causative factor is necessary to cure this condition.
