Pancytopenia is a medical condition in which there is significant reduction in the number of almost all blood cells ( red blood cells,

white blood cell White blood cells, also called leukocytes or leucocytes, are the cell (biology), cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and de ...

s, platelets, monocytes, lymphocytes, etc.). If only two parameters from the complete blood count are low, the term bicytopenia can be used. The diagnostic approach is the same as for pancytopenia.

Causes

Iatrogenic causes of pancytopenia include chemotherapy for malignancies if the drug or drugs used cause bone marrow suppression. Rarely, drugs ( antibiotics, blood pressure medication, heart medication) can cause pancytopenia. For example, the antibiotic

chloramphenicol Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes use as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to treat meningitis, plague, cholera, a ...

can cause pancytopenia in some individuals. Rarely, pancytopenia may have other causes, such as mononucleosis or other viral diseases. Increasingly, HIV is itself a cause of pancytopenia. * Familial hemophagocytic syndrome *

Aplastic anemia Aplastic anemia is a cancer in which the body fails to make blood cells in sufficient numbers. Blood cells are produced in the bone marrow by stem cells that reside there. Aplastic anemia causes a deficiency of all blood cell types: red blood ...

* Gaucher's disease * Metastatic carcinoma of bone *

Multiple Myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Often, no symptoms are noticed initially. As it progresses, bone pain, an ...

* Overwhelming infections * Lymphoma * Myelofibrosis * Dyskeratosis congenita * Myelodysplastic syndrome * Leukemia *

Leishmaniasis Leishmaniasis is a wide array of clinical manifestations caused by parasites of the trypanosome genus ''Leishmania''. It is generally spread through the bite of phlebotomine sandflies, ''Phlebotomus'' and ''Lutzomyia'', and occurs most freq ...

* Severe folate or vitamin B12 deficiency *

Systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...

* Paroxysmal nocturnal hemoglobinuria (blood test) * Viral infections (such as HIV, EBV; an undetermined virus is most common) *

Alimentary toxic aleukia Alimentary toxic aleukia is a mycotoxin-induced condition characterized by nausea, vomiting, diarrhea, leukopenia (aleukia), hemorrhaging, skin inflammation, and sometimes death. Alimentary toxic aleukia almost always refers to the human condition ...

* Copper deficiency * Pernicious anemia * Medication *

Hypersplenism Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant (LUQ) of the human abdomen. Splenomegaly is one of the four cardinal signs of ''hypersplenism'' which include: some reduction in number of circulati ...

* Osteopetrosis * Organic acidurias (Propionic Acidemia, Methylmalonic Aciduria, Isovaleric Aciduria) * Low dose arsenic poisoning * Sako disease (Myelodysplastic-cytosis) * Chronic radiation sickness * LIG4 syndrome

Mechanism

Common concept is pancytopenia can occur either due to mother cells are decreased themselves in number (aplastic anemia), mother cells are overwhelmed by malignant cells (Leukemia, lymphoma, MDS) or they are being sequestrated (spleen)/destroyed (immune) outside bone marrow. The mechanisms for pancytopenia differ according to the

etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

. For example, in hemophagocytic lymphohistiocytosis (HLH) there is marked inappropriate and ineffective T cell activation that leads to an increased hemophagocytic activity. The T cell activated

macrophage Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer cel ...

s engulf erythrocytes, leukocytes, platelets, as well as their progenitor cells. Along with pancytopenia, HLH is characterized by fever, splenomegaly, and hemophagocytosis in

bone marrow Bone marrow is a semi-solid tissue found within the spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It is composed of hematopoietic ce ...

, liver, or

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

Diagnosis

Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes. * anemia: hemoglobin < 13.5 g/dL (male) or < 12 g/dL (female). * leukopenia: total white cell count < 4.0 x 10⁹/L. Decrease in all types of white blood cells (revealed by doing a differential count). * thrombocytopenia: platelet count < 150×10⁹/L.

Treatment

Treatment is done to address the underlying cause. To tide over immediate crisis Blood transfusion with packed red blood cells (PRBC) or platelet transfusion may be done. Sometimes there are obvious clinical clues to suggest underlying B12 deficiency for a cause of pancytopenia. In this selected cases even with severe anemia blood product transfusions can be avoided and vitamin B12 treatment itself suffice. In other situations like acute leukemia, Myelodysplastic syndrome, aplastic anemia etc. disease specific therapy is needed.

References

External links

EID Journal (Volume 6, Number 6)
CDC, December 2000. {{Medical resources , DiseasesDB = 24135 , ICD10 = {{ICD10, D, 61, 9, d, 61 , ICD9 = {{ICD9, 284.1 , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = D010198 Blood disorders Hematopathology