The pancytopenia is a hematologic condition that occurs when the body has a low count of three types of blood cells: red cells, white cells and platelets. This is usually associated with problems with the bone marrow, which is where blood cells are made.
Several blood diseases are often the cause of pancytopenia: anemia (low level of red blood cells), leukopenia (low level of white blood cells) and thrombocytopenia (low level of platelets).
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All can have pancytopenia as a final outcome, since usually, in the long run, these diseases tend to atrophy the bone marrow, an organ that is found under the cortex of the large bones of our body, responsible for producing each of these cell lines.
The human body needs all blood cells in optimal levels and functioning. Without treatment, pancytopenia can even put the patient's life at risk, due to its significant systemic repercussions.
Symptoms
Many times pancytopenia can go unnoticed without causing symptoms, other times it arises as a complication of diseases with very frank symptoms, such as cancer, the presence of severe infections where bacteria reach the blood (sepsis), and even in some cases there are medications that can cause it.
Many of the symptoms can easily be associated with the lack of different blood cells.
The decrease in red blood cells, being responsible for transporting oxygen, can generate fatigue and respiratory problems in the patient.
White blood cells are responsible for preventing infections. By having a low number of white blood cells, they are more prone to contracting different types of infections, some common such as a cold or pneumonia, others caused by organisms that can only cause infection when the body's defenses are reduced (pneumocystosis, cytomegalovirus, for example).
Platelets are responsible for generating blood clots that help wounds heal. Therefore, in its absence, you are more prone to easy bleeding and bruising.
Other symptoms that usually occur commonly are:
-Pallor
-High heart rate
-Fever
-Dizziness
- Skin rash
More serious symptoms that require immediate medical attention would be:
- seizures
- Loss of consciousness
- Uncontrollable blood loss
- Difficulty breathing
Causes
The main causes of pancytopenia can vary based on geographic location. However, pancytopenia is generally caused by the bone marrow's difficulty in producing new blood cells.
Among the most common causes of pancytopenia are:
-Megaloblastic anemia: it is one of the most common causes in developing countries, caused by the lack of vitamin B12 in the human body, in which the body produces a large number of immature red blood cells larger than normal and has a low count of them
- Infections: numerous infections can be the cause. Pancytopenia is usually common in patients with an advanced state of human immunodeficiency virus (HIV). Different types of hepatitis can cause transient pancytopenia and are usually associated with medullary aplasia, this being a usually fatal combination.
In countries where tuberculosis or brucellosis is common, they are also often the cause of pancytopenia.
Viral infections, however, are the most common infectious cause of pancytopenia worldwide. Among these infections we have parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), as some examples.
- Acute leukemias: also known as cancer of the blood cells, it is usually very common in premature and long-lived ages. Symptoms generally indicate bone marrow failure.
- Medullary aplasia: it is a condition in which the body stops producing enough new blood cells, causing pancytopenia. It is associated with infections and reactions to medications. In this case, the bone marrow usually undergoes a degenerative process, and turns into fatty tissue, unable to produce blood cells.
- Chemotherapy and radiation: this is one of the most common causes and is a reaction that cancer patients may have when undergoing this type of treatment, since they seek to eliminate cancer cells, and end up attacking other tissues, in in this case the bone marrow.
Complications
Complications with pancytopenia stem from the lack of the blood's formed elements, as discussed earlier.
In the case of anemia, it can be caused by a wide range of diseases, both genetic and acquired throughout life, each with its own idiosyncrasies.
However, respiratory failure is a late and common manifestation in anemia, because the different tissues of the body do not receive the necessary amounts of oxygen that they demand.
In the case of white blood cells, hospitalizations due to severe infections is very common in these types of patients. Skin, digestive and respiratory infections (pneumonia) are usually the most common.
The problem in these patients is that these infections are caused by microorganisms resistant to antibiotic treatment, which normally could not cause damage in the body thanks to the presence of white blood cells. This is why they tend to invade the blood and cause sepsis more easily than other infections.
Finally, the severe deficiency of platelets leads to repeated bleeding episodes, usually at the level of the gums and nose. In patients older than 50 years, bleeding through the anus is not uncommon.
When the bleeding is so massive that the internal organs begin to fail, a clinical condition known as shock occurs, which can be fatal within a few minutes.
Treatment
Treatment will always depend on the problem that caused the pancytopenia. It generally usually includes treatment for bone marrow problems.
If the blood cells are dangerously low, some treatments could be:
- Blood transfusion
- Medicines that stimulate the growth of blood cells
- Stem cell transplantation
- Bone marrow transplant
Prevention
Many times, due to the nature of the cause, it is impossible to prevent pancytopenia. However, many of the diseases that lead to pancytopenia can be treated in time to avoid reaching this dreaded complication.
For this reason, it is important to go to a medical consultation when any worrisome symptoms occur, as well as to go to medical check-ups to rule out diseases that increase in incidence with age (colon cancer, prostate cancer, breast cancer)
It is also important to avoid taking medications without a medical indication, since pancytopenia is an important side effect of many medications, although the vast majority require a prescription to be purchased.
References
- Pedro M. Rubio Aparicio, Susana Riesco (2012). From the laboratory to the clinic. Pancytopenia: clinical and diagnostic evaluation.
- Ajai Kumar Garg, AK Agarwal, GD Sharma (2017). Pancytopenia: Clinical approach. Taken from apiindia.org.
- Rachel Nal, RN, BSN, CCRN. (2017). What you should know about pancytopenia. Medical News Today. Taken from medicalnewstoday.com.
- Suzanne Falck, MD. (2017). What Is Pancytopenia ?. Health Line. Taken from healthline.com.
- Pancytopenia, sf, st jude children's research hospital. Taken from stjude.org.