A client is admitted to the hospital with pancytopenia as a result of chemotherapy

Overview

Pancytopenia is a condition in which a person’s body has too few red blood cells, white blood cells, and platelets. Each of these blood cell types has a different job in the body:

• Red blood cells carry oxygen throughout your body.
• White blood cells are part of your immune system and help fight off infections.
• Platelets allow your blood to form clots.

If you have pancytopenia, you have a combination of three different blood diseases:

• anemia, or low level of red blood cells
• leukopenia, or low level of white blood cells
• thrombocytopenia, or low platelet levels

Because your body needs all of these blood cells, pancytopenia can be very serious. It can even be life-threatening if you don’t treat it.

Mild pancytopenia often doesn’t cause symptoms. Your doctor might discover it while doing a blood test for another reason.

More severe pancytopenia can cause symptoms including:

• shortness of breath
• pale skin
• fatigue
• weakness
• fever
• dizziness
• easy bruising
• bleeding
• tiny purple spots on your skin, called petechiae
• larger purple spots on your skin, called purpura
• bleeding gums and nosebleeds
• fast heart rate

If you or someone close to you has any of the following serious symptoms and pancytopenia, get medical care right away:

• fever over 101˚F (38.3˚C)
• seizures
• heavy bleeding
• severe shortness of breath
• confusion
• loss of consciousness

Pancytopenia starts because of a problem with your bone marrow. This spongy tissue inside bones is where blood cells are produced. Diseases and exposure to certain drugs and chemicals can lead to this bone marrow damage.

You’re more likely to develop pancytopenia if you have one of these conditions:

• cancers that affect the bone marrow, such as:
  • leukemia
  • multiple myeloma
  • Hodgkin’s or non-Hodgkin’s lymphoma
  • myelodysplastic syndromes
  • megaloblastic anemia, a condition in which your body produces larger-than-normal, immature red blood cells and you have a low red blood cell count
• aplastic anemia, a condition in which your body stops making enough new blood cells
• paroxysmal nocturnal hemoglobinuria, a rare blood disease that causes red blood cells to be destroyed
• viral infections, such as:
  • Epstein-Barr virus, which causes mononucleosis
  • cytomegalovirus
  • HIV
  • hepatitis
  • malaria
  • sepsis (a blood infection)
• diseases that damage bone marrow, such as Gaucher disease
• damage from chemotherapy or radiation treatments for cancer
• exposure to chemicals in the environment, such as radiation, arsenic, or benzene
• bone marrow disorders that run in families
• vitamin deficiencies, such as lack of vitamin B-12 or folate
• enlargement of your spleen, known as splenomegaly
• liver disease
• excess alcohol use that damages your liver
• autoimmune diseases, such as systemic lupus erythematosus

In about half of all cases, doctors can’t find a cause for pancytopenia. This is called idiopathic pancytopenia.

Complications from pancytopenia stem from a lack of red blood cells, white blood cells, and platelets. These problems can include:

• excess bleeding if platelets are affected
• increased risk for infections if white blood cells are affected

Severe pancytopenia can be life-threatening.

If your doctor suspects you have pancytopenia, they’ll likely recommend that you see a hematologist — a specialist who treats blood diseases. This specialist will want to learn your family history and personal medical history. During the exam, the doctor will ask about your symptoms and look at your ears, nose, throat, mouth, and skin.

The doctor will also do a complete blood count (CBC). This test measures the amount of red blood cells, white blood cells, and platelets in your blood. If the CBC is abnormal, you might need a peripheral blood smear. This test places a drop of your blood on a slide to look at the different types of blood cells it contains.

To look for a problem with your bone marrow, your doctor will likely do a bone marrow aspiration and biopsy. In this test, your doctor uses a needle to remove a small amount of liquid and tissue from inside your bone that can then be tested and examined in a lab.

Your doctor might also do separate tests to look for the cause of pancytopenia. These tests can include blood tests to check for infections or leukemia. You might also need a CT scan or other imaging test to look for cancer or other problems with your organs.

Your doctor will treat the problem that caused pancytopenia. This might include taking you off a medicine or stopping your exposure to a certain chemical. If your immune system is attacking your bone marrow, you’ll get medicine to dampen your body’s immune response.

Treatments for pancytopenia include:

• drugs to stimulate blood cell production in your bone marrow
• blood transfusions to replace red blood cells, white blood cells, and platelets
• antibiotics to treat an infection
• a bone marrow transplant, also known as a stem cell transplant, which replaces damaged bone marrow with healthy stem cells that rebuild bone marrow

The outlook for pancytopenia depends on what disease caused the condition and how your doctor treats it. If a drug or chemical caused pancytopenia, it should get better within a week after you stop the exposure. Some conditions, like cancer, will take longer to treat.

Some causes of pancytopenia, like cancer or inherited bone marrow diseases, aren’t preventable. You may be able to prevent certain types of infection with good hygiene practices and by avoiding contact with anyone who is sick. You can also avoid chemicals that are known to cause this condition.