Bone marrow failure (BMF) is when your bone marrow doesn’t make enough platelets, red blood cells or white blood cells. BMF can be acquired or inherited. The main symptoms include bleeding, bruising and fatigue. Treatments include blood transfusions and stem cell transplant. BMF increases risk of other conditions and needs lifelong treatment.
Bone marrow failure (BMF) is when the soft center of your bones (bone marrow), where your blood cells are made, isn’t working right. You have three kinds of blood cells:
Bone marrow failure can appear in children or adults. It can be dangerous and may be associated with other conditions, including cancer.
There are two types of bone marrow failure:
Researchers estimate that inherited bone marrow failure (IBMFS) affects roughly 65 out of 1 million people born each year. IBMFS leads to 30% of bone marrow failure disorders in children.
Fanconi anemia is the most common type of inherited bone marrow failure disorder. It affects from 1 to 5 out of every 1 million people. The incidence is higher in people of Romani (Spain), Boer (South Africa) or Ashkenazi Jewish heritage.
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Symptoms vary by the specific bone marrow failure syndrome, but the main symptoms of bone marrow failure are:
Genetic mutations cause inherited bone marrow failure. One or both of your biological parents may carry a gene they pass on to you, or you may develop a new mutation that causes it.
Acquired bone marrow failure causes include:
Sometimes, providers don’t know the cause of acquired bone marrow failure (idiopathic).
Sometimes, bone marrow failure is part of a group of related signs and symptoms (a syndrome).
The most common types of inherited bone marrow failure syndromes (IBMFS) include:
Less common types of IBMFS include:
The most common type of acquired bone marrow failure syndrome is acquired aplastic anemia.
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People of every age, race and sex can have bone marrow failure. People often first show symptoms during one of these age ranges:
Children of preschool age have more inherited bone marrow failure, while older adults have more acquired bone marrow failure.
You’re especially at risk of IBMFS if one or both of your parents carry a genetic mutation for a bone marrow failure syndrome. Most inherited bone marrow failure syndromes are autosomal recessive disorders. This means that both of your parents have a mutation associated with the same BMF, though they may not show symptoms. As their child, there’s a 25% chance that you’ll also have the BMF.
Some inherited bone marrow failure syndromes are autosomal dominant disorders. This means that one of your parents has a BMF and the symptoms of that condition. As their child, there’s a 50% chance that you’ll also have bone marrow failure.
A healthcare provider will first ask about your symptoms, your medical history and your family medical history. They’ll also do a physical exam.
Your provider will do a complete blood count (CBC), which looks at your levels of red blood cells, white blood cells and platelets. If you have BMF, these levels will be low.
Depending on what disease your provider suspects, they may also do tests like:
To rule out acquired bone marrow failure, your provider may:
Your provider may also suggest genetic testing. This test can find changes in your genes that cause bone marrow failure syndrome.
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Your treatment will depend on:
It’s considered a medical emergency if you have a very low white blood cell count in your bone marrow (neutropenia). In this case, your provider may recommend hospitalization or antibiotics. If you also have a fever, they may treat you for potential infections using antivirals or antifungals.
Treatments for bone marrow failure may include:
Many times, these treatments help relieve symptoms for only a short time. A bone marrow transplant (stem cell transplant) is the only treatment shown to help for a longer time. During this procedure, a surgeon replaces your damaged cells with healthy ones from a donor.
You may be a good candidate for a stem cell transplant if you:
Unfortunately, you can’t reduce your risk of congenital bone marrow failure. Avoiding chemicals that are associated with bone marrow suppression can prevent some acquired bone marrow failure. And prompt treatment can help to relieve your symptoms and improve your quality of life.
Bone marrow disease can be a lifelong health condition. Your provider may want to closely monitor you, even if you’re feeling well.
Life expectancy for people with bone marrow failure can range from months to a full lifespan. Life expectancy varies by a person’s:
If you have life-threatening bone marrow failure, you’ll need immediate treatment by a doctor who specializes in blood (hematologist) or cancer (oncologist). Many people with BMFS need a provider to monitor their condition for their entire lives.
The outlook depends on the cause and severity of your bone marrow failure. Even with treatment, people with BMF have an increased risk of:
Take care of your general health, including eating healthy foods, exercising and avoiding tobacco and alcohol use. You should also see your provider on a regular basis. They can monitor you for any changes and provide prompt treatment with antibiotics, blood infusions or medications as needed.
You should see your healthcare provider immediately if you notice any new or worsening symptoms.
If you plan to become pregnant, you may want to talk to your provider about genetic counseling.
A note from Cleveland Clinic
Symptoms of bone marrow failure (BMF) — like bleeding, bruising, fatigue and shortness of breath — can cause stress and worry. Your provider can recommend treatments to help you manage symptoms. You may be a candidate for a stem cell transplant. You’ll work closely with your care team for the rest of your life, so it’s important to find an expert team you can trust.
Last reviewed on 04/19/2023.
Learn more about the Health Library and our editorial process.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy