Pancytopenia is a lab finding. In this condition all the three cell lines in blood are reduced. They are red blood cells, white blood cells and platelets. The symptoms are caused by a decreased number of these cells.
What is pancytopenia?
So pancytopenia is a lab finding in which all the three cell lines of the blood are reduced in number. It is a combination of anemia, leukopenia and thrombocytopenia.
The blood contains red blood cells, white blood cells, and platelets. In this condition all these types of cells are reduced in the blood.
Red cells contain haemoglobin and they carry oxygen to and nutrients to various organs of the body. Reduced RBC count can manifest as anemia.
White blood cells are part of immunity and they have a major role in fighting various infections and keeping you healthy. Reduced WBC count is called leukocytopenia.
Platelets are plate-like cells in blood that have a major role in formation of clots so that you do not bleed excessively after injury.
For normal day to day life all these cell types are very important. Any decrease in any or all of these cell types can cause serious symptoms. Reduced platelet or thrombocytes count is called thrombocytopenia.
What are symptoms of pancytopenia?
As we discussed earlier in pancytopenia all these cell types are reduced. The symptoms of pancytopenia include a combination of anemia, leukopenia and thrombocytopenia.
Following are the symptoms of pancytopenia.
- Fatigue: Reduced RBC count causing anemia may cause fatigue even at rest or even after routine activities.
- Feeling of weakness: Reduced hemoglobin and anemia can cause feelings of weakness.
- Decreased appetite.
- Growth failure: Inability to grow weight and height in children.
- Rapid breathing and difficulty in breathing after walking or climbing stairs.
- Palpitations are feelings of rapid heart beats even after routine work.
- Swelling of hands and feet.
- In extreme cases of anemia can cause heart failure.
- Reduced WBC count can cause multiple infections. It can cause repeated infections because of reduced immunity. It can cause bacteremia and sepsis.
- Even common mild infections like viral fever and flu can cause complications in such patients.
- Reduced platelet count, the thrombocytopenia can cause bleeding and violet or red spots called purpura on skin.
- Increased bleeding at the time of the menstruation.
- Anemia can cause various complications in pregnancy and after pregnancy.
What are the causes of pancytopenia?
As we discussed earlier pancytopenia is a lab finding. It is caused by a variety of conditions and diseases. Causes are as follows:
- Idiopathic: In many cases of the pancytopenia cause can not be found. It is called an idiopathic condition.
- HIV is the most common cause of pancytopenia. HIV infection itself or the treatment of HIV can cause reduced cell count of the blood cells.
- Malaria in some people can cause this condition manifesting as reduced cell counts of the all three cell lines.
- Diseases in which bone marrow is affected like gaucher disease.
- Various cancers that affect bone marrow can cause pancytopenia leukemia, hodgkin disease lymphoma, multiple myeloma.
- Vitamin deficiency like vitamin B12 and folate deficiency can cause this condition. It is called megaloblastic anemia.
- Chemotherapy and radiation therapy for various cancers.
- Environmental exposure to toxins like arsenic.
- Autoimmune disease like systemic lupus erythematosus.
- Rare conditions like paroxysmal nocturnal hemoglobinuria.
- Excess alcohol intake.
- Various liver diseases like hepatitis.
- Other viral infections like epstein barr virus and cytomegalovirus, rarely hepatitis causing virus like Hepatitis A infections.
- Splenomegaly is a condition in which spleen size is enlarged and spleen functions excessively destroying the blood cells.
What are complications of pancytopenia?
Pancytopenia can cause life threatening complications which are as follows:
- Heart failure.
- Excessive bleeding.
- Various life threatening infections like sepsis and bacteremia.
What tests are needed in pancytopenia?
Patients visit a doctor for the above mentioned symptoms. After examining the patient and taking thorough history, the doctor suggests a simple blood test called HBCBC or hemogram.
CBC test or hemogram can be carried out with the help of an automated machine. It suggests reduced cell counts of all the three cell lines. The findings are confirmed on peripheral blood smear with peripheral blood smear examination.
To find the cause of the conditions the doctor orders tests to diagnose infections like HIV ELISA and western blot, peripheral smear to detect malaria parasites, anti hepatitis A antibodies.
Vitamin B12 and folate deficiency can be diagnosed by examining the vitamin levels in blood and urine tests.
If the bone marrow disease is suspected, bone marrow aspiration or bone marrow biopsy can be done to confirm. In this test a sample of bone marrow is aspirated with a needle and examined in the lab.
For some conditions like cancer imaging with CT scan and MRI may be needed.
What is the treatment of pancytopenia?
Treatment of pancytopenia is tricky and depends upon severity and underlying cause of the condition.
As the work up needed for the diagnosis is extensive, mostly investigation and treatment is carried out in hospital settings after admission of the patient.
Hematologist’s opinion may add value to the treatment and diagnosis. It is best to manage pancytopenia cases under the care of a hematologist.
If the specific cause is found for the condition treatment directed aganst this specific cause is always recommended.
Vitamin defficiency like B12 and folate defficiency can be treated with oral and injectable suppliments of these vitamins.
For conditions like HIV and HIV treatment causing this condition opinion of infectous disease specialist or HIV specialist should be sought. It may need modification in HIV treatment.
For severe anemia blood transfusion may be needed for rapid correction of the anemia.
Severe thrombocytopenia with bleeding manifestations needs platelet transfusion to avoid bleeding complications.
Increased risk of infection caused by severe reduction in WBC count needs prophylactic antibiotic therapy.
Drugs like filgrastim, erythropoietin and romiplostim can stimulate bone marrow for cell production of various lines.
In some autoimmune cases and idiopathic cases a course of steroids may be helpful. Steroids should be started cautiously after ruling out causes like cancer and infections.