What Are the Signs and Symptoms of Pancytopenia?

What is pancytopenia?

Pancytopenia is a condition in which you are low in all three types of blood cells: white blood cells, red blood cells, and platelets. Signs and symptoms inculde feeling weak, tired, dizzy, fever, chills, bruising, nosebleeds, and bleeding gums.

Humans have three types of blood cells: white blood cells, red blood cells, and platelets. Certain conditions can cause you to be low in one or more types. Pancytopenia is a condition in which you are low in all three types. Pancytopenia symptoms include pale skin, shortness of breath, and fatigue. Pancytopenia may indicate a problem in the bone marrow, which produces blood cells.

Pancytopenia is a combination of three cytopenias, or conditions of reduced blood cell counts:

Anemia is a low count of red blood cells.
Leukopenia is a low count of white blood cells.
Thrombocytopenia is a lack of platelets.

Normal blood cell counts can vary somewhat according to gender, age, and other conditions.

Signs and symptoms of pancytopenia

Persons with pancytopenia may not show signs of all three conditions. More commonly, you would present with symptoms of a reduction in red blood cells, white blood cells, or platelets, rather than showing symptoms of all three.

Symptoms associated with low red blood cells

Persons with pancytopenia may report symptoms associated with anemia. You may feel tired, weak, dizzy, or short of breath. You may also experience palpitations or a rapid heartbeat with exertion. Older individuals or those with heart problems may report chest pain or angina. Persons with anemia are sometimes pale, which doctors can observe by looking at the skin, nail bed, and inside the eyelid.

Symptoms associated with low white blood cells

There are several types of white blood cells. Most symptoms come from a shortage of neutrophils, the most numerous white blood cells, which fight infections. If you have a shortage of neutrophils, you may experience fever, chills, and frequent illnesses.

Symptoms associated with low platelets

The first symptom of low platelets is often easy bruising. As platelet levels drop, other symptoms may appear, such as nosebleeds and bleeding gums. You may also notice tiny spots on the skin called petechiae, which are usually red, brown, or purple in color. These appear most commonly on the shins and back of the throat.

Pancytopenia can also cause enlargement of the spleen, liver, and lymph nodes.

Causes of pancytopenia

Causes of pancytopenia may vary according to regions of the world. In North America, many cases are neoplastic, meaning related to the uncontrolled growth of cells, both benign and malignant. In less developed countries, nutritional deficiencies cause many cases. Around half the cases of pancytopenia are idiopathic, meaning the cause is never known. The most common causes of pancytopenia include:

Poor nutrition

Megaloblastic anemia is a common cause of pancytopenia in many parts of the world. It is caused by deficiencies of folate and vitamin B-12. It is easily remedied with nutritional supplements and an improved diet. Megaloblastic anemia is often related to poverty, vegan and vegetarian diets, and poor eating habits.

Cancer

Cancers of the blood can cause pancytopenia, although they are not the most common cause. Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are two types that may trigger low blood cell counts. Therapies used for cancer, such as radiation and chemotherapy, can also affect the blood marrow and result in pancytopenia.

Drugs and toxins

Several medications can cause pancytopenia. These include sulfa drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), and some drugs used to treat epilepsy. Toxins such as benzene and arsenic may also be responsible for pancytopenia {St. Jude Children's Research Hospital: “Pancytopenia.”}.

Infections

Pancytopenia can result from overwhelming infections, including tuberculosis, severe fungal infections, and human immunodeficiency virus (HIV). Infections that are secondary to HIV can also cause pancytopenia.

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Diagnosis of pancytopenia

A complete blood count (CBC) can lead to a diagnosis of pancytopenia. It's more difficult to determine the underlying cause so that treatment can begin. Doctors usually start by taking a complete medical history, performing a physical exam, and running further lab tests. Often these steps will show the cause. If they do not, and the pancytopenia is severe, doctors usually perform a bone marrow aspiration and biopsy to collect and analyze your bone marrow.

Treatments of pancytopenia

If pancytopenia is not severe, careful monitoring may be the only treatment necessary. Sometimes doctors delay treatment because it could interfere with finding a diagnosis.

Ideally, treatment of pancytopenia consists of treating the underlying cause, but sometimes doctors must address the low blood cell counts too. They may order transfusions of red blood cells and platelets. White blood cells are seldom transfused, but sometimes neutrophil production can be stimulated.

Treating the underlying cause of pancytopenia may be as simple as changing medications or giving nutritional supplements. It may also call for more aggressive treatments, such as a stem cell transplant.