Pancytopenia

What is pancytopenia?

Pancytopenia describes having low levels of all three blood cell types: red blood cells, white blood cells and platelets. Low levels of each type correspond with specific conditions.

• Low red blood cells: Red blood cells supply oxygen to tissues throughout your body. An essential protein called hemoglobin helps your red blood cells transport oxygen. Having lower-than-normal levels of red blood cells or hemoglobin is called anemia.
• Low white blood cells: White blood cells (leukocytes) help your body fight infection. Neutrophils are the most common type of white blood cell in your body. Having lower-than-normal levels of white blood cells is called leukopenia. Having low levels of neutrophils is called neutropenia.
• Low platelets: Platelets help your blood clot to control bleeding. Having lower-than-normal levels of platelets is called thrombocytopenia.

If you have pancytopenia, you may have symptoms associated with some or all of these conditions, depending on how low your levels are.

How common is pancytopenia?

Pancytopenia is likely common. It has multiple potential causes — so many that it’s hard to know exactly how many people have it during their lifetimes.

What are the symptoms of pancytopenia?

Pancytopenia may be so mild that you may not notice symptoms until a provider discovers low levels during routine blood work. In other instances, pancytopenia is severe and potentially life-threatening without emergency care.

Anemia symptoms (low red blood cells)

If you don’t have enough red blood cells, the organs and tissues throughout your body can’t get enough oxygen. Symptoms include:

• Fatigue.
• Shortness of breath (dyspnea).
• Dizziness.
• Headache.
• Rapid or irregular heartbeat (arrhythmia).
• Pale or clammy skin.

Leukopenia symptoms (low white blood cells)

Not having enough white blood cells can make you more susceptible to infections. These infections can cause symptoms that include:

• Fatigue.
• Fever and chills.
• Sore throat (pharyngitis).
• Mouth sores.
• Severe cough.
• Diarrhea.
• Shortness of breath.
• Swollen lymph nodes.
• Cuts or sores that drain pus.

Thrombocytopenia symptoms (low platelets)

A low level of platelets prevents your blood from clotting as it should. Symptoms include:

• Bruising easily.
• Heavy or prolonged bleeding.
• Heavy menstrual bleeding.
• Blood in your poop, urine or vomit.
• Markings on your skin from bleeding just beneath the skin, including red or purple dots resembling a rash (petechiae) or red, purple or brown spots on your skin (purpura).

What causes pancytopenia?

Pancytopenia usually involves a problem with blood cell production in your bone marrow. Your blood cells are made in your bone marrow during a process called hematopoiesis. Once they’re fully mature, they leave the marrow and circulate in your bloodstream.

Pancytopenia may result if your bone marrow doesn’t produce enough healthy blood cells or if these blood cells get destroyed.

Multiple conditions can interfere with blood cell production or lead to their destruction.

In rare cases, healthcare providers can’t determine what’s causing the low levels. This is called idiopathic pancytopenia.

Blood or bone marrow disorders

Certain conditions cause bone marrow to produce abnormal blood cells. Most of these conditions are acquired (something you develop over time). Some are inherited (something you’re born with). Conditions include:

• Aplastic anemia.
• Fanconi anemia.
• Diamond-Blackfan anemia.

Cancer

Cancer cells can invade your bone marrow, reducing the production of healthy blood cells. Cancers that can cause pancytopenia include:

• Leukemia.
• Lymphoma.
• Multiple myeloma.
• Myelofibrosis.
• Myelodysplastic syndromes.
• Cancer that’s spread from another part of your body to your bone marrow (metastatic cancer).

Nutritional deficiencies and alcohol intake

Your body may not have enough nutrients, like Vitamin B12 and folate, to make healthy blood cells. Or, pancytopenia may relate to how much alcohol you drink. Excessive alcohol use is an important and common cause of pancytopenia.

Infectious diseases

Viruses can cause pancytopenia. Conditions include:

• Mononucleosis (mono).
• HIV (human immunodeficiency virus).
• Hepatitis C.
• Parvovirus B19.
• Tuberculosis.
• Malaria.

Autoimmune conditions

Your body’s immune cells can attack healthy blood cells. Autoimmune diseases that can cause pancytopenia include:

• Lupus.
• Rheumatoid arthritis.

Drug treatments

Some types of drugs, including several chemotherapy drugs, suppress blood cell production.

Exposure to toxins

Poisons in your environment, including benzene and arsenic, can damage your blood cells. Low levels can also result from radiation exposure.

Splenic sequestration

Some conditions may cause blood cells to get trapped in your spleen. Autoimmune conditions, cirrhosis of the liver and some cancers are all potential causes. When this happens, your spleen may enlarge (splenomegaly) and feel painful.

Who is at risk for pancytopenia?

Anyone with the above conditions may be at risk for pancytopenia. Still, you may be more likely to have it if you have a family history of blood disorders or if you’re receiving chemotherapy treatments that interfere with blood cell production.

How is pancytopenia diagnosed?

A standard blood test called a complete blood count (CBC) can show if your levels are low. Values can vary depending on various factors, including your age, race and health.

Low levels are as follows:

• Red blood cells: Less than 4.2 million cells per microliter of blood or lower than 12 grams (g) per deciliter of hemoglobin in women and people assigned female at birth (AFAB). Less than 4.7 million cells per microliter of blood or lower than 13 grams per deciliter of hemoglobin in men and people assigned male at birth (AMAB).
• White blood cells: Less than 4,000 white blood cells per microliter of blood or an absolute neutrophil count of fewer than 1800 neutrophils per microliter of blood. Neutrophil levels are important because most white blood cells are neutrophils.
• Platelets: Less than 150,000 platelets per microliter of blood.

What tests will be done to determine the cause?

Once your healthcare provider determines that you have pancytopenia, they may perform various tests to determine what’s causing your low levels. You may need to see a hematologist — a healthcare provider who specializes in diagnosing, treating and managing blood conditions — for diagnosis and treatment.

Tests may include:

• Peripheral blood smear: This test allows your provider to examine cells beneath a microscope. Abnormal-looking cells may provide clues about what’s causing your low levels.
• Vitamin B12 and folate levels tests: Nutritional deficiencies commonly cause pancytopenia. Checking your B12 and folate levels can help your provider determine if this is the cause.
• Bone marrow aspiration and biopsy: A healthcare provider removes a bone marrow sample and tests it for signs of potential diseases that cause pancytopenia, like cancer.

Depending on your test results, medical history and symptoms, your provider may also test for other potential causes, including:

• Viruses.
• Infections.
• Autoimmune conditions.
• Genetic mutations (changes in your DNA).

How is pancytopenia treated?

Treatment involves curing or managing the underlying condition and reducing symptoms. You may also receive treatments that directly increase your blood cells. These include:

• Medications: Certain medicines can spur your bone marrow to produce more blood cells.
• Blood transfusion: You may need an infusion of red blood cells or platelets if your low levels risk harming your health.
• Stem cell or bone marrow transplant: These procedures replace unhealthy stem cells (the cells in your bone marrow that give rise to mature blood cells) with healthy stem cells.

You may need to take broad-spectrum antibiotics if your neutrophils are extremely low, putting you at high risk of infection.

What can I expect if I have pancytopenia?

Your outlook depends on what’s causing your low levels. No data currently exist on the survival or success rates associated with pancytopenia treatments. Instead, researchers track outcomes according to treatment responses associated with the underlying condition.

As treatments for the underlying conditions improve, so do the outcomes associated with pancytopenia. It’s important to talk to your provider about your outlook. They can share the latest research findings and explain what they mean in relation to your situation.

Is pancytopenia serious?

It can be, depending on what’s causing your low levels. Your healthcare provider will work to determine the cause (and how serious it is) if you have pancytopenia.

When should I go to the ER?

Severe cases of pancytopenia can be life-threatening without treatment. Visit an ER (emergency room) immediately if you experience the following symptoms:

• Fever higher than 101 degrees Fahrenheit (38 degrees Celsius).
• Loss of consciousness (blacking out).
• Severe shortness of breath.
• Sudden confusion.
• New onset headache.
• Severe blood loss.
• Chest pain.
• Seizure.

A note from Cleveland Clinic

Pancytopenia may affect you in various ways depending on how low your levels are and the underlying cause. Follow your healthcare provider’s guidance on how to care for yourself if your low levels put you at risk of developing anemia, infection or excessive bleeding. Ask about symptoms to look out for that warrant scheduling a visit with your provider.