Pancytopenia

Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets.

If only two parameters from the full blood count are low, the term bicytopenia can be used. The diagnostic approach is the same as for pancytopenia.

Definition

• anemia : hemoglobin < 13 g/dl (male) or 12 g/dl (female)
• neutropenia < 1.5 G/l
• thrombocytopenia < 150 G/l

Causes

Pancytopenia is generally due to diseases affecting the bone marrow, although peripheral destruction of all lines of blood cells in hypersplenism (overactive spleen) is a recognised cause. Bone marrow problems causing pancytopenia include myelofibrosis, leukemia, aplastic anemia, Fanconi anemia and the malignant form of osteoporosis.

Pancytopenia can also be caused by familial hemophagocytic syndrome, which is a type of immunodeficiency syndrome. The disease is marked by an inappropriate and ineffective T cell activation that leads to an increased hemophagocytic activity. The T cell activated macrophages engulf erythrocytes, leukocytes, platelets, as well as their progenitor cells. Such finding is common in the syndrome, which is also referred to as hemophagocytic lymphohistiocytosis (HLH). Along with pancytopenia, HLH is characterized by fever, splenomegaly, and hemophagocytosis in bone marrow, liver, or lymph nodes.

Iatrogenic causes of pancytopenia include chemotherapy for malignancies if the drug or drugs used cause bone marrow suppression. Rarely, drugs (antibiotics, blood pressure medication, heart medication) can cause pancytopenia. The antibiotic Linezolid can cause pancytopenia in some individuals.

Increasingly, HIV is itself a cause for pancytopenia.

Diagnosis

Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes.

Causes of pancytopenia

1. Familial Hemophagocytic Syndrome
2. Aplastic anemia
3. Dyskeratosis congenita
4. Myelodysplastic syndrome
5. Leukemia
6. Leishmaniasis
7. Severe Folate or Vitamin B12 deficiency
8. Systemic Lupus Erythematosus
9. Paroxysmal nocturnal hemoglobinuria (Urine test)
10. Finally overwhelming viral infections (HIV most common).
11. Alimentary Toxic Aleukia (ATA)
12. Copper deficiency

See also

• Leukopenia, a reduction in white blood cells
• Neutropenia, a reduction in neutrophil granulocytes

References

1. http://www.med.univ-angers.fr/discipline/lab_hema/aetiopancyto.html

External links

Wikimedia Commons has media related to: Hemophagocytic Infections and Syndromes

• CDC

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