Pancytopenia: what is it, symptoms and main causes

Pancytopenia corresponds to the simultaneous decrease in the number of blood cells, and to go down, to the decrease in the number of erythrocytes, leukocytes and platelets, which generates signs and symptoms such as pallor, tiredness, bruising, bleeding, fever and tendency to infections.

This condition can arise from a decrease in the production of cells by the bone marrow, due to situations such as vitamin deficiency, genetic diseases, leukemia or leishmaniasis; or by a destruction of the formed blood cells, due to immune diseases or diseases that stimulate the action of the blood, for example.

The treatment for pancytopenia must be carried out following the instructions of the general physician or the hematologist according to the cause of the pancytopenia, which may include the use of corticosteroids, immunosuppressants, antibiotics, blood transfusions or extraction of the blood, for example, the blood vessels are indicated depending on the needs of each patient.

main symptoms

The signs and symptoms of pancytopenia are related to the reduction of red globules, white globules and blood platelets, including the main ones:

Depending on the case, there may also be signs and symptoms related to the illness that causes pancytopenia, such as an increase in the size of the abdomen due to an increase in the size of the bazo, enlarged lymph nodes, malformations in the bones or alterations in the skin, for example.

Causes of pancytopenia

Pancytopenia can occur due to two situations: when the bone marrow does not produce blood cells correctly or when the bone marrow produces them correctly, but the cells are destroyed in the blood circulation. The main causes of pancytopenia are:

• Use of toxic drugs, as certain antibiotics, chemotherapeutics, antidepressants, anticonvulsants and sedatives;
• Radiation effects or chemical agents, such as benzene and DDT, for example;
• Vitamin B12 or folic acid deficiency in the feeding;
• genetic diseases, like Fanconi anemia, congenital dyskeratosis or Gaucher disease;
• Bone marrow disorders, such as myelodysplastic syndrome, myelofibrosis or paroxysmal nocturnal hemoglobinuria;
• autoimmune diseases, such as lupus, Sjörgren’s syndrome or autoimmune lymphoproliferative syndrome;
• infectious diseases, such as leishmaniasis, brucellosis, tuberculosis or HIV;
• Cancer, such as leukemias, multiple myeloma, myelofibrosis or bone marrow metastasis of other types of cancer;
• Diseases that stimulate the action of the bazo and the defense cells of the organism to destroy blood cells, such as liver cirrhosis, myeloproliferative diseases and hemophagocytic syndromes.

Asimism, acute infectious diseases caused by bacteria or viruses, such as cytomegalovirus (CMV), can provoke a strong immune reaction of the organism, which can be able to destroy blood cells in an acute way during the course of the infection.

How is the diagnosis performed?

The diagnosis of pancytopenia is carried out by means of a hemogram, in which the levels of red blood cells, white blood cells and reduced platelets are verified. However, it is also important to identify the cause that provoked the pancytopenia, an action that must be carried out by the general physician or the hematologist through the observation of the clinical history and the physical examination performed on the patient. Similarly, it is possible to recommend the performance of other tests to identify the cause of pancytopenia, such as:

• Serum elevation, ferritin, transferrin saturation and reticulocyte count;
• Measurement of vitamin B12 and folic acid levels;
• Search for infections;
• Blood coagulation profile;
• Pruebas inmunitarias, like direct Coombs;
• Myelogram, in which the bone marrow is aspirated to obtain more details about the characteristics of the cells of this region;
• Bone marrow biopsy, which evaluates the characteristics of the cells, presence of infiltrations by cancer, other diseases and fibrosis.

Specific exams can also be requested for the disease that the doctor looks up, such as the case of immunoelectrophoresis for multiple myeloma or the cultivation of the bone marrow to identify infections, such as leishmaniasis, for example.

How is the treatment performed?

The treatment for pancytopenia is indicated by the hematologist in accordance with the cause, which may include the use of drugs that act on the immunity, such as Methylprednisolone or Prednisone; or immunosuppressants, such as Ciclosporin, in the case of autoimmune or inflammatory diseases. Furthermore, in the event that the pancytopenia is due to cancer, the treatment may involve bone marrow transplantation.

When dealing with infections, specific treatments are indicated for each microorganism, such as antibiotics, antivirals or pentavalent antimonials, as for example in the case of leishmaniasis. On the other hand, blood transfusion is not always indicated, being necessary only in severe cases that require a quick recovery, depending on the cause.