Pancytopenia: Difference between revisions
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For example, the antibiotic [[chloramphenicol]] can cause pancytopenia in some individuals.<ref>{{Citation|last=Abdollahi|first=M.|title=Chloramphenicol|date=2014|url=https://linkinghub.elsevier.com/retrieve/pii/B9780123864543007090|work=Encyclopedia of Toxicology|pages=837–840|publisher=Elsevier|language=en|doi=10.1016/b978-0-12-386454-3.00709-0|isbn=978-0-12-386455-0|access-date=2020-12-11|last2=Mostafalou|first2=S.}}</ref> |
For example, the antibiotic [[chloramphenicol]] can cause pancytopenia in some individuals.<ref>{{Citation|last=Abdollahi|first=M.|title=Chloramphenicol|date=2014|url=https://linkinghub.elsevier.com/retrieve/pii/B9780123864543007090|work=Encyclopedia of Toxicology|pages=837–840|publisher=Elsevier|language=en|doi=10.1016/b978-0-12-386454-3.00709-0|isbn=978-0-12-386455-0|access-date=2020-12-11|last2=Mostafalou|first2=S.}}</ref> |
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Rarely, pancytopenia may have other causes, such as [[Infectious mononucleosis|mononucleosis]] or other viral diseases. Increasingly, [[HIV]] is itself a cause of pancytopenia.{{ |
Rarely, pancytopenia may have other causes, such as [[Infectious mononucleosis|mononucleosis]] or other viral diseases. Increasingly, [[HIV]] is itself a cause of pancytopenia.<ref>{{Cite journal|last=Jain|first=Arvind|last2=Naniwadekar|first2=Manjiri|date=2013-11-06|title=An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital|url=https://doi.org/10.1186/2052-1839-13-10|journal=BMC Blood Disorders|volume=13|issue=1|pages=10|doi=10.1186/2052-1839-13-10|issn=1471-2326|pmc=PMC4177001|pmid=24238033}}</ref> |
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* Familial [[Hemophagocytic lymphohistiocytosis|hemophagocytic syndrome]] |
* Familial [[Hemophagocytic lymphohistiocytosis|hemophagocytic syndrome]] |
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* [[Aplastic anemia]] |
* [[Aplastic anemia]] |
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==Mechanism== |
==Mechanism== |
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The mechanisms for pancytopenia differ according to the [[etiology]]. For example, in [[hemophagocytic lymphohistiocytosis]] (HLH) there is marked inappropriate and ineffective [[T cell]] activation that leads to an increased hemophagocytic activity. The T cell activated [[macrophage]]s engulf erythrocytes, leukocytes, platelets, as well as their [[progenitor cell]]s. Along with pancytopenia, HLH is characterized by [[fever]], [[splenomegaly]], and hemophagocytosis in [[bone marrow]], [[liver]], or [[lymph node]]s.{{ |
The mechanisms for pancytopenia differ according to the [[etiology]]. For example, in [[hemophagocytic lymphohistiocytosis]] (HLH) there is marked inappropriate and ineffective [[T cell]] activation that leads to an increased hemophagocytic activity. The T cell activated [[macrophage]]s engulf erythrocytes, leukocytes, platelets, as well as their [[progenitor cell]]s. Along with pancytopenia, HLH is characterized by [[fever]], [[splenomegaly]], and hemophagocytosis in [[bone marrow]], [[liver]], or [[lymph node]]s.<ref>{{Cite journal|last=Trottestam|first=Helena|last2=Horne|first2=AnnaCarin|last3=Aricò|first3=Maurizio|last4=Egeler|first4=R. Maarten|last5=Filipovich|first5=Alexandra H.|last6=Gadner|first6=Helmut|last7=Imashuku|first7=Shinsaku|last8=Ladisch|first8=Stephan|last9=Webb|first9=David|last10=Janka|first10=Gritta|last11=Henter|first11=Jan-Inge|date=2011-10-27|title=Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208276/|journal=Blood|volume=118|issue=17|pages=4577–4584|doi=10.1182/blood-2011-06-356261|issn=0006-4971|pmc=3208276|pmid=21900192}}</ref> |
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== Diagnosis == |
== Diagnosis == |
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Pancytopenia usually requires a [[bone marrow biopsy]] in order to distinguish among different causes.{{ |
Pancytopenia usually requires a [[bone marrow biopsy]] in order to distinguish among different causes.<ref>{{Cite web|title=Rudhiram Hematology Clinic - Google Search|url=https://www.google.com/search?q=Rudhiram+Hematology+Clinic&ludocid=5150959102409787010&lpsid=CIHM0ogKEICAgIDmueTdBg&source=sh/x/localposts&lsig=AB86z5XrzWBckbIx8_P21jwulFPG|access-date=2022-02-02|website=www.google.com}}</ref> |
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* [[anemia]]: hemoglobin < 13.5 g/dL (male) or 12 g/dL (female). |
* [[anemia]]: hemoglobin < 13.5 g/dL (male) or 12 g/dL (female). |
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* [[leukopenia]]: total white cell count < 4.0 x 10<sup>9</sup>/L. Decrease in all types of white blood cells (revealed by doing a differential count). |
* [[leukopenia]]: total white cell count < 4.0 x 10<sup>9</sup>/L. Decrease in all types of white blood cells (revealed by doing a differential count). |
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==Treatment== |
==Treatment== |
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Treatment is done to address the underlying cause. To tide over immediate crisis [[Blood transfusion]] with [[packed red blood cells]] (PRBC) or platelet transfusion may be done. Sometimes there are obvious clinical clues to suggest underlying B12 deficiency for a cause of pancytopenia.<ref>{{Cite journal|last=Devalia|first=Vinod|last2=Hamilton|first2=Malcolm S.|last3=Molloy|first3=Anne M.|date=2014|title=Guidelines for the diagnosis and treatment of cobalamin and folate disorders|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.12959|journal=British Journal of Haematology|language=en|volume=166|issue=4|pages=496–513|doi=10.1111/bjh.12959|issn=1365-2141}}</ref> In this selected cases even with severe anemia blood product transfusions can be avoided and vitamin B12 treatment itself suffice.<ref>{{Cite journal|last=Devalia|first=Vinod|last2=Hamilton|first2=Malcolm S.|last3=Molloy|first3=Anne M.|date=2014|title=Guidelines for the diagnosis and treatment of cobalamin and folate disorders|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.12959|journal=British Journal of Haematology|language=en|volume=166|issue=4|pages=496–513|doi=10.1111/bjh.12959|issn=1365-2141}}</ref> In other situations like acute leukemia, Myelodysplastic syndrome, aplastic anemia etc disease specific therapy is needed.<ref>{{Cite journal|last=Risitano|first=Antonio M.|last2=Maciejewski|first2=Jaroslaw P.|last3=Selleri|first3=Carmine|last4=Rotoli|first4=Bruno|last5=Risitano|first5=Antonio M.|last6=Maciejewski|first6=Jaroslaw P.|title=Function and Malfunction of Hematopoietic Stem Cells in Primary Bone Marrow Failure Syndromes|url=https://www.eurekaselect.com/article/22446|journal=Current Stem Cell Research & Therapy|language=en|volume=2|issue=1|pages=39–52}}</ref> |
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Treatment is done to address the underlying cause. [[Blood transfusion]] with [[packed red blood cells]] (PRBC) may be indicated according to need.{{cn|date=November 2021}} |
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== References == |
== References == |
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Revision as of 19:25, 2 February 2022
 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (July 2020) |  |
| Pancytopenia | |
|---|---|
| Specialty | Hematology |
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 complete blood count are low, the term bicytopenia can be used. The diagnostic approach is the same as for pancytopenia.
Causes
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. For example, the antibiotic chloramphenicol can cause pancytopenia in some individuals.[1]
Rarely, pancytopenia may have other causes, such as mononucleosis or other viral diseases. Increasingly, HIV is itself a cause of pancytopenia.[2]
- Familial hemophagocytic syndrome
- Aplastic anemia
- Gaucher's disease
- Metastatic carcinoma of bone
- Multiple Myeloma
- Overwhelming infections
- Lymphoma
- Myelofibrosis
- Dyskeratosis congenita
- Myelodysplastic syndrome
- Leukemia
- Leishmaniasis
- Severe folate or vitamin B12 deficiency
- Systemic lupus erythematosus
- Paroxysmal nocturnal hemoglobinuria (blood test)
- Viral infections (such as HIV, EBV; an undetermined virus is most common)
- Alimentary toxic aleukia
- Copper deficiency
- Pernicious anemia
- Medication
- Hypersplenism
- Osteopetrosis
- Organic acidurias (Propionic Acidemia, Methylmalonic Aciduria, Isovaleric Aciduria)
- Low dose arsenic poisoning
- Sako disease (Myelodysplastic-cytosis)
- Chronic radiation sickness[3]
- LIG4 syndrome
Mechanism
The mechanisms for pancytopenia differ according to the etiology. For example, in hemophagocytic lymphohistiocytosis (HLH) there is marked 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. Along with pancytopenia, HLH is characterized by fever, splenomegaly, and hemophagocytosis in bone marrow, liver, or lymph nodes.[4]
Diagnosis
Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes.[5]
- anemia: hemoglobin < 13.5 g/dL (male) or 12 g/dL (female).
- leukopenia: total white cell count < 4.0 x 109/L. Decrease in all types of white blood cells (revealed by doing a differential count).
- thrombocytopenia: platelet count < 150×109/L.
Treatment
Treatment is done to address the underlying cause. To tide over immediate crisis Blood transfusion with packed red blood cells (PRBC) or platelet transfusion may be done. Sometimes there are obvious clinical clues to suggest underlying B12 deficiency for a cause of pancytopenia.[6] In this selected cases even with severe anemia blood product transfusions can be avoided and vitamin B12 treatment itself suffice.[7] In other situations like acute leukemia, Myelodysplastic syndrome, aplastic anemia etc disease specific therapy is needed.[8]
References
- ^ Abdollahi, M.; Mostafalou, S. (2014), "Chloramphenicol", Encyclopedia of Toxicology, Elsevier, pp. 837–840, doi:10.1016/b978-0-12-386454-3.00709-0, ISBN 978-0-12-386455-0, retrieved 2020-12-11
- ^ Jain, Arvind; Naniwadekar, Manjiri (2013-11-06). "An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital". BMC Blood Disorders. 13 (1): 10. doi:10.1186/2052-1839-13-10. ISSN 1471-2326. PMC 4177001. PMID 24238033.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Kossenko MM, Akleyev AA, Degteva MO, Kozheurov VP, Degtyaryova RC (August 1994). "Analysis of Chronic Radiation Sickness Cases in the Population of the Southern Urals (AD-A286 238)". DTIC. p. 5. Retrieved 1 August 2013.
Complete blood counts, when taken, revealed pancytopenia.
- ^ Trottestam, Helena; Horne, AnnaCarin; Aricò, Maurizio; Egeler, R. Maarten; Filipovich, Alexandra H.; Gadner, Helmut; Imashuku, Shinsaku; Ladisch, Stephan; Webb, David; Janka, Gritta; Henter, Jan-Inge (2011-10-27). "Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol". Blood. 118 (17): 4577–4584. doi:10.1182/blood-2011-06-356261. ISSN 0006-4971. PMC 3208276. PMID 21900192.
- ^ "Rudhiram Hematology Clinic - Google Search". www.google.com. Retrieved 2022-02-02.
- ^ Devalia, Vinod; Hamilton, Malcolm S.; Molloy, Anne M. (2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". British Journal of Haematology. 166 (4): 496–513. doi:10.1111/bjh.12959. ISSN 1365-2141.
- ^ Devalia, Vinod; Hamilton, Malcolm S.; Molloy, Anne M. (2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". British Journal of Haematology. 166 (4): 496–513. doi:10.1111/bjh.12959. ISSN 1365-2141.
- ^ Risitano, Antonio M.; Maciejewski, Jaroslaw P.; Selleri, Carmine; Rotoli, Bruno; Risitano, Antonio M.; Maciejewski, Jaroslaw P. "Function and Malfunction of Hematopoietic Stem Cells in Primary Bone Marrow Failure Syndromes". Current Stem Cell Research & Therapy. 2 (1): 39–52.
External links
- EID Journal (Volume 6, Number 6), CDC, December 2000.