Pancytopenia corresponds to the decrease in all blood cells, that is, it is the decrease in the number of red blood cells, leukocytes and platelets, which causes signs and symptoms such as pallor, tiredness, bruising, bleeding, fever and tendency to infections.
It can arise either because of a decrease in the production of cells by the bone marrow, due to situations such as vitamin deficiency, genetic diseases, leukemia or leishmaniasis, as well as by a destruction of blood cells in the bloodstream, due to immune or stimulating action diseases. of the spleen, for example.
Treatment for pancytopenia should be done according to the guidelines of the general practitioner or hematologist according to the cause of pancytopenia, which may include the use of corticosteroids, immunosuppressants, antibiotics, blood transfusions, or the removal of the spleen, for example, which are only indicated according to the needs of each patient.
Main symptoms
The signs and symptoms of pancytopenia are related to the reduction of red blood cells, leukocytes and platelets in the blood, the main ones being:
| Red blood cell reduction | Leukocyte reduction | Platelet reduction |
| It results in anemia, causing pallor, weakness, tiredness, dizziness, palpitations. | It impairs the action of the immune system, increases the tendency to infections and fever. | It makes blood clotting difficult, increasing the risk of bleeding, and leads to bruises, bruises, petechiae, hemorrhages. |
Depending on the case, there may also be signs and symptoms resulting from the disease that causes pancytopenia, such as enlarged abdomen due to an enlarged spleen, enlarged lymph nodes, malformations in the bones or changes in the skin, for example.
Causes of pancytopenia
Pancytopenia can happen due to two situations: when the bone marrow does not produce blood cells correctly or when the bone marrow produces correctly but the cells are destroyed in the bloodstream. The main causes of pancytopenia are:
- Use of toxic drugs, such as some antibiotics, chemotherapy, antidepressants, anticonvulsants and sedatives; Effects of radiation or chemical agents, such as benzene or DDT, for example; Deficiency of vitamin B12 or folic acid in the diet; Genetic diseases, such as Fanconi anemia, congenital dyskeratosis or Gaucher disease; Bone marrow disorders, such as myelodysplastic syndrome, myelofibrosis or nocturnal paroxysmal hemoglobinuria; Autoimmune diseases, such as lupus, Sjogren's syndrome or autoimmune lymphoproliferative syndrome; Infectious diseases, such as leishmaniasis, brucellosis, tuberculosis or HIV; Cancer, such as leukemia, multiple myeloma, myelofibrosis or metastasis of other cancers to the bone marrow. Diseases that stimulate the action of the spleen and defense cells of the body to destroy blood cells, such as liver cirrhosis, myeloproliferative diseases and hemophagocytic syndromes.
In addition, acute infectious diseases caused by bacteria or viruses, such as cytomegalovirus (CMV), can cause a strong immune reaction in the body, capable of destroying blood cells acutely during the course of infection.
How is the diagnosis
The diagnosis of pancytopenia is made through the blood count, in which the levels of red blood cells, leukocytes and reduced platelets in the blood are checked. However, it is also important to identify the cause that led to pancytopenia, which must be done through the evaluation of the general practitioner or hematologist through observation of the clinical history and physical examination performed on the patient. In addition, other tests may be recommended to identify the cause of pancytopenia, such as:
- Serum iron research, ferritin, transferrin saturation and reticulocyte count; Vitamin B12 and folic acid measurement; Infection research; Blood clotting profile; Immunological tests, such as direct Coombs; Myelogram, in which the bone marrow is aspirated for more information about the cell characteristics of this location. Check how the myelogram is made and when it is indicated; Bone marrow biopsy, which assesses the characteristics of the cells, the presence of infiltrations by cancer or other diseases and fibrosis. Find out how bone marrow biopsy is done and what it is for.
Specific tests may also be ordered for the disease that the doctor suspects, such as immunoelectrophoresis for multiple myeloma or bone marrow culture to identify infections, such as leishmaniasis, for example.
How the treatment is done
The treatment of pancytopenia is guided by the hematologist according to its cause, and may include the use of drugs that act on immunity, such as Methylprednisolone or Prednisone, or immunosuppressants, such as Cyclosporine, in the case of autoimmune or inflammatory diseases. In addition, if pancytopenia is due to cancer, treatment may involve bone marrow transplantation.
In the case of infections, specific treatments are indicated for each microorganism, such as antibiotics, antivirals or pentavalent antimonials in the case of leishmaniasis, for example. Blood transfusion is not always indicated, but it may be necessary in severe cases that require rapid recovery, depending on the cause.
