Pancytopenia
A condition with low red cells, white cells, and platelets.
Pancytopenia is a medical condition characterized by a significant reduction in nearly all types of blood cells, including red blood cells, white blood cells, and platelets. When only two blood cell lines are low, the term bicytopenia is used, and the diagnostic approach remains the same as for pancytopenia. The condition is notable for its broad range of underlying causes and the frequent need for bone marrow biopsy to identify them.
Quick Facts
- Field
- Hematology
Facts from the source article.
Causes
Iatrogenic causes include chemotherapy for malignancies that suppress bone marrow, and rarely drugs such as antibiotics, blood pressure medication, or heart medication. The antibiotic chloramphenicol can cause pancytopenia in some individuals. Other causes include viral infections like mononucleosis or HIV, aplastic anemia, Gaucher's disease, metastatic carcinoma of bone, multiple myeloma, overwhelming infections, lymphoma, myelofibrosis, dyskeratosis congenita, myelodysplastic syndrome, leukemia, leishmaniasis, severe folate or vitamin B12 deficiency, systemic lupus erythematosus, paroxysmal nocturnal hemoglobinuria, alimentary toxic aleukia, copper deficiency, pernicious anemia, hypersplenism, osteopetrosis, organic acidurias, low dose arsenic poisoning, Sako disease, chronic radiation sickness, LIG4 syndrome, and familial hemophagocytic syndrome.
Mechanism
The mechanism of pancytopenia involves either decreased blood cell production in the bone marrow (aplastic anemia), displacement of hematopoietic stem cells by malignant cells (leukemia, lymphoma, myelodysplastic syndrome), or pooling in the spleen or destruction outside the marrow. In hemophagocytic lymphohistiocytosis, inappropriate T cell activation leads to increased hemophagocytic activity, where macrophages engulf erythrocytes, leukocytes, platelets, and their progenitor cells, accompanied by fever, splenomegaly, and hemophagocytosis in bone marrow, liver, or lymph nodes.
Treatment
Treatment addresses the underlying cause. For immediate crisis, blood transfusion with packed red blood cells or platelet transfusion may be performed. In cases of B12 deficiency, vitamin B12 treatment alone may suffice, avoiding transfusions even with severe anemia. For conditions such as acute leukemia, myelodysplastic syndrome, or aplastic anemia, disease-specific therapy is required.
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