What Causes Pancytopenia and How It's Treated

Pancytopenia describes low levels of all types of blood cells including red blood cells, white blood cells, and platelets. It happens when there is a problem with the stem cells in your bone marrow that produce blood cells.

Pancytopenia can lead to symptoms of anemia (low red blood cells), leukopenia (low white blood cells), and thrombocytopenia (low platelets). These symptoms may include fatigue, infections, and bruising.

What Is Pancytopenia?

When you have pancytopenia, you have a deficiency in all three major types of blood cells. Specifically, these include:

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

These terms are used for lower levels of blood cells:

• Anemia: A low level of red blood cells
• Leukopenia: A low level of white blood cells
• Thrombocytopenia: A low level of platelets is referred to as thrombocytopenia

Is Pancytopenia Common?

Pancytopenia may be more common than reported. Studies have found an incidence of between 1% and 13%. Since it has multiple possible causes, it's difficult to know how many people will develop it at some point during their lives.

Pancytopenia Symptoms

Not everyone with pancytopenia will experience symptoms. When the condition does cause symptoms, they may include weakness, an enlarged spleen, and symptoms related to deficiency of specific blood cells.

Symptoms are related to low levels of each specific type of blood cell:

Anemia

Low levels of red blood cells can cause symptoms such as:

• Fatigue
  
• Feeling out of breath
• Dizziness
• Headache
• Paleness

Leukopenia

Low white blood cells can cause symptoms such as:

• Fatigue
• Fever and chills
• Mouth sores or sore throat
• Cough
  

Thrombocytopenia

Low platelets interfere with your blood's ability to clot. This may cause symptoms such as:

• Easy bruising or petechiae (tiny spots under the skin)
• Heavy bleeding
• Blood in your urine or stool
  

Pancytopenia Causes

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

This may involve bone marrow destruction by toxins, bone marrow suppression (during chemotherapy), or the replacement of bone marrow by other cells, which can disrupt blood cell production, as can occur with some cancers. Blood cell destruction or suppression may also 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.

Some of the possible causes of pancytopenia include:

Medications

Certain drugs are known to cause pancytopenia. Some of these include:

• Chemotherapy drugs that suppress bone marrow function
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Colchicine, a medication prescribed to prevent or treat gout
• Antibiotics such as chloramphenicol, linezolid, and sulfonamides
• Phenothiazines, a class of antipsychotic drugs
• Thiazides, a class of diuretics used to treat heart conditions
• Anti-thyroid medications
• Anti-epileptics
• Anti-diabetics

Autoimmune Conditions

Certain autoimmune conditions that cause the body to mistakenly attack healthy blood cells can lead to pancytopenia. These include:

• Lupus
• Rheumatoid arthritis
  

Infectious Diseases

Viral illness can also cause pancytopenia. Some of the conditions that may cause this include:

• Mononucleosis
• HIV
• Parvovirus
• Hepatitis
• Tuberculosis
• Malaria
• Sepsis

Anemia

Some types of anemia affect the bone marrow, causing the production of abnormal cells. These include:

• Aplastic anemia
• Fanconi anemia
• Diamond-Blackfan anemia
  

Cancer

Pancytopenia can be caused by cancers that affect the bone marrow, but it can also be caused by cancers that start elsewhere in the body and spread.

• Blood and bone marrow cancers such as leukemia, lymphoma, myeloma, and myelofibrosis
• Spread of some solid tumors to the bone marrow, especially breast cancer, prostate cancer, colon cancer, gastric cancer, and melanoma, which usually causes anemia followed by thrombocytopenia
• Myelodysplastic syndromes ("pre-cancerous" conditions of the bone marrow)

Splenic Sequestration

Splenic sequestration occurs when blood cells get trapped in the spleen so they are unable to reach the rest of the body. This can happen with autoimmune conditions or more chronic conditions such as cirrhosis of the liver. Splenic sequestration may cause an enlarged, painful spleen.

Toxins

Exposure to certain chemicals and toxins can also cause pancytopenia. For example:

• Toxins and chemicals such as arsenic or benzene
• Radiation
  

Most Common Causes

Some of the most commonly seen causes of pancytopenia include:

• Acute leukemia
• Megaloblastic anemia
• Aplastic anemia
• Hypersplenism
• Multiple myeloma
• Myelodysplastic syndrome
• Infections
• Lymphoma
  

Diagnosis and Testing

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

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

If it appears that you have pancytopenia, the next step is often a bone marrow biopsy.

A bone marrow biopsy looks at the components of bone marrow, which include hematopoietic stem cells (the cells that differentiate into all of the different types of blood cells), blood cells in various phases of maturation, and supplies used to make blood cells, such as iron and vitamin B12.

In addition to checking B12 levels in the blood, special stains and tests are performed on the cells to look for changes, such as chromosomal and gene changes, often found with leukemias.

Pancytopenia Treatment

The goal of treating pancytopenia is to find and treat the underlying cause. If the cause is unknown, or if the pancytopenia is expected, such as chemotherapy, treatment is aimed at minimizing the symptoms related to the deficiency of blood cells. Some treatments that may be used include:

• Drugs that stimulate the bone marrow: For chemotherapy-induced neutropenia and some other causes, the growth factors Leukine, Neupogen, Neulasta, or Ryzneuta may be used to stimulate the formation of WBCs. For chemotherapy-induced anemia, some medications may be considered.
• Blood transfusions
• Immunosuppressive drugs if the cause is due to an autoimmune condition
• Bone marrow transplant or stem cell transplant

Summary

Several different conditions can cause pancytopenia, including bone marrow diseases, some cancers, and some infections; chemotherapy treatment can also cause pancytopenia.

The treatment options for pancytopenia depend on the specific causes and usually focus on increasing the levels of cells to improve symptoms while treating the underlying cause.