What Is Pancytopenia?
When all three peripheral blood lineages are decreased, a hematologic condition can be referred to as peripheral pancytopenia. It is characterized by a low hemoglobin value (less than 13 g/dL in men and 12 g/dL in women). Pancytopenia involves a condition when a person’s body has few red blood cells (anemia), white blood cells (leukemia), and thrombocytopenia (low platelet levels). The condition is more common in children and young adults. Pancytopenia can be categorized as a
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Low production of new blood cells by the bone marrow (spongy tissue inside the bones). The primary type of pancytopenia involves production disorders caused mainly secondary by nutritional deficiencies, like folate and vitamin B12. Other factors, such as alcoholism, malabsorption, infections, and certain drugs, can also contribute to poor absorption of nutrients.
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Peripheral pancytopenia involves disorders of increased destruction of the existing blood cells. Certain autoimmune conditions, such as rheumatoid arthritis (a chronic inflammatory disease affecting joints in the hands and feet) and systemic lupus (an autoimmune disorder involving inflammation of tissues), can destroy the blood cells.
What Causes Peripheral Pancytopenia?
Peripheral pancytopenia is associated with the destruction of cells in autoimmune conditions like
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Systemic Lupus Erythematosus - An autoimmune disease that causes the immune system to attack healthy, normal tissues, leading to organ inflammation and tissue damage.
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Rheumatoid Arthritis - An autoimmune disease causing inflammation and swelling in the joints, especially of the hands and feet.
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Splenic Sequestration - A life-threatening condition in which the blood cells pool or get trapped in the spleen. The medical emergency is commonly seen as a complication of sickle cell anemia (an inherited blood disorder affecting the shape of the red blood cells and does not last only for a few days).
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Chemotherapy Drugs - It involves suppression and destruction of the bone marrow that may result in necrosis or fibrosis of the blood cells.
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Aplastic Anemia - A rare condition that develops due to bone marrow damage and stops new blood cell production.
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Infections - Viral infections, like Epstein-Barr virus (a human herpes virus), human immunodeficiency virus (HIV), malaria, cytomegalovirus (Herpes virus), and hepatitis.
What Are the Symptoms of Pancytopenia?
Mild pancytopenia does not cause noticeable symptoms and is usually identified while doing blood tests for another reason.
The symptoms of severe pancytopenia may include
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Shortness of breath.
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Weakness.
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Fatigue.
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Dizziness.
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Easy bruising.
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Fever.
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Pale skin.
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Bleeding easily.
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Fast heart rate.
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Petechia (small purple spots on the skin).
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Purpura (large purple spots on the skin).
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Bleeding gums.
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Nosebleed.
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Rashes.
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Swollen lymph nodes.
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Ulcers.
Specific symptoms, such as confusion, seizures, shortness of breath, excessive blood loss, or loss of consciousness, may require immediate medical attention.
How Is Pancytopenia Diagnosed?
Pancytopenia is associated with multiple diseases that may be life-threatening. Hence, it is mandatory to have a detailed history and examination to establish a diagnosis for proper management.
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Medical History - The doctor may refer one to a hematologist or specialist for treating blood diseases). The hematologist takes a whole family and personal medical history.
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Physical Examination - The doctor might do a physical examination to look for signs of bleeding spots or petechiae in the ears, nose, throat, mouth, and skin.
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Blood Count - The doctor may recommend a complete blood count to measure the blood's white blood cells, red blood cells, and platelets. An abnormal blood count may require a peripheral blood smear to look at the different types of blood cells.
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Bone Marrow Aspiration - A small amount of fluid is removed from the bone to examine the bone marrow.
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Biopsy - A small amount of tissue is taken from the bone to examine in the lab for signs of pancytopenia, like infections or leukemia.
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CT Scan - Imaging tests, like computed tomography (CT), may be done to look for cancers or other problems.
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Other Tests - Various tests, like thyroid tests or liver function tests, can help identify other diseases.
What Is the Treatment of Pancytopenia?
An accurate diagnosis of the root cause of pancytopenia is essential for the proper treatment. The treatment for pancytopenia is based on the cause and the seriousness of the condition that includes
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Nutrition - Deficiencies in nutrition must be treated
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Diseases - To treat the underlying disease, infections, like tuberculosis or HIV, that have caused the condition. The doctor may also prescribe some medicines to stimulate the production of blood cells in the bone marrow.
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Medications - Stop certain medications, like antibiotics or chemotherapy drugs, that may have led to the condition. Antibiotics may be prescribed to treat certain infections.
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Toxins - In cases where pancytopenia has been caused by exposure to certain toxins or environmental problems, removal of the toxin can reduce the symptoms
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Bone Marrow Transplant - A bone marrow or stem cell transplant may be performed to replace the impaired bone marrow with healthy stem cells that can rebuild the bone marrow.
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A Blood Transfusion - This is performed to replace the damaged red blood cells, white blood cells, and platelets.
Lifestyle Measures for the Prevention of Peripheral Pancytopenia:
Some prevention and lifestyle measures for peripheral pancytopenia include:
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Maintain a Healthy Diet: Eating a well-balanced diet rich in vitamin B12, iron, and folic acid might help prevent anemia and other blood disorders that may contribute to pancytopenia.
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Avoid Exposure to Toxins: Exposure to toxins, such as radiation, chemicals, and pesticides, can damage the bone marrow and lead to pancytopenia. It is important to avoid exposure to these substances as much as possible.
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Practice Good Hygiene: Repeated hand washing and avoiding contact with individuals who are sick can help prevent infections that can lead to pancytopenia.
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Exercise Regularly: Regular exercise can also improve blood circulation and promote the production of healthy blood cells.
Prognosis:
The prognosis of pancytopenia depends on the underlying condition and can be reversed by discontinuing specific drug therapies. It also depends on the degree of pancytopenia and the percentage of destruction of the blood cells. The condition might cause complications that can be life-threatening, like increased infections, severe anemia, or severe bleeding.
Conclusion:
Pancytopenia is a severe condition involving a reduced number of blood cells. Any person with symptoms that may indicate pancytopenia should consult a doctor. A good diagnosis and follow-up treatment can somewhat prevent the spread and severity of the condition. Prompt initiation of antibiotic therapy can benefit patients with fever and lower the risk of sepsis and infection. Patients should be educated about medication and over-the-counter supplements' adverse reactions and toxicities. They should be counseled on the complications and educated on the importance of periodic evaluation and blood work.
