What Is Pancytopenia?

Your body has three types of blood cells: red blood cells, white blood cells, and platelets. When all three of these blood cells are below normal limits, you can develop a condition called pancytopenia.

In other words, pancytopenia is a combination of anemia (too few red blood cells), leukopenia (too few white blood cells), and thrombocytopenia (too few platelets).

Most of the time, pancytopenia occurs when there is a problem with the stem cells in your bone marrow. Pancytopenia can cause you to feel fatigued and dizzy. You might also develop a fast heartbeat.

Pancytopenia is somewhat common because of how many conditions with which it's associated. Because it’s linked to so many conditions, it’s hard to know exactly how often pancytopenia occurs or who is more likely to develop it.

Symptoms

If your pancytopenia is mild, you might not show any symptoms.

If you do experience symptoms with pancytopenia, the symptoms can be wide-ranging. The most common symptoms are:

• Fever
• Fatigue
• Dizziness
• Weight loss
• Pale skin 

You can experience symptoms of any one of the three conditions that compose pancytopenia:

Other conditions you may have can influence pancytopenia symptoms. For instance, if you have an underlying liver disease, you may exhibit signs of anorexia, nausea, or lethargy. People with too many blood cells in their spleen (splenic sequestration) may have pain in their left upper quadrant. People with autoimmune disorders or cancer might develop more general symptoms like unexplained weight loss and fatigue.

What Causes Pancytopenia?

Pancytopenia is not a disease in itself. Rather, it is an occurrence brought on by infections, autoimmune disorders, genetic factors, nutritional deficiencies, or certain types of cancer.  

The following may cause pancytopenia:

• Megaloblastic anemia (when you have very large red blood cells)
• Aplastic anemia (when your bone marrow can’t make enough new blood cells)
• Overactive spleen
• Leukemia
• Chemical toxins
• Chemotherapy
• Radiation exposure
• Certain medications 

In about half of all cases of pancytopenia, the cause is unknown.

Whatever is behind the pancytopenia is leading to either a decreased production or increased destruction of the red blood cells, white blood cells, and platelets and, in turn, causing the pancytopenia.

Risk Factors

There are a number of risk factors that increase the likelihood that you will develop pancytopenia. Risk factors include having:

• Chemotherapy treatment
• Certain infections like sepsis or mononucleosis
• Certain cancers or pre-cancerous syndromes like myelodysplastic syndromes 
• Aplastic anemia
• Chronic liver disease
• A thyroid condition
• An autoimmune disorder
• A vitamin B12 deficiency 

How Is Pancytopenia Diagnosed?

If your pancytopenia is mild and you are not experiencing any symptoms, you may find out that you have the condition only after completing a complete blood count. A complete blood count is a routine blood test that measures different aspects of your blood, including the levels of red blood cells, white blood cells, and platelets.

If you are experiencing any symptoms of pancytopenia, your healthcare provider might order a complete blood count to check your blood cell levels. Your provider also may order a peripheral blood smear to look at your blood cells and platelets under a microscope.

If you have pancytopenia, your blood work will show deficient levels of all three types of blood cells. With pancytopenia, your levels will fall below the following normal ranges:

In addition to bloodwork, your provider may use other diagnostic tests to determine the underlying cause of pancytopenia. These tests will vary depending on your symptoms and can find out whether you have any conditions that are related to pancytopenia. The tests may include:

• Bone marrow aspiration and biopsy, which is the taking and testing of a small sample of bone marrow from the hip, thigh, or breastbone, may be ordered to establish pancytopenia.
• An infectious workup, which is a series of tests looking for infections, can be ordered if HIV, tuberculosis, or another infection is suspected.
• A thyroid panel, which is a blood test that evaluates the functioning of the thyroid, may be ordered to check for hyperthyroidism. 
• A blood draw to check your vitamin B12 and folate levels may be requested.
• A liver function test, which is a blood test, may be ordered to check for liver disease or damage. 

Treatment

Treatment of pancytopenia often involves treating pancytopenia itself as well as the underlying cause of the condition. 

Treating Pancytopenia Itself

When it comes to treating pancytopenia, it will depend on how severe your condition is. Mild cases of pancytopenia may just be monitored while more severe cases may require more intervention like:

• A blood transfusion
• Stem cell transplant
• Drugs to suppress your immune system
• Medication to stimulate bone marrow 

Treating the Underlying Causes of Pancytopenia

If your pancytopenia is caused by a known factor, that disease or illness will need to be treated as well. For instance, if you have a vitamin B12 deficiency, this can be addressed through diet and supplements.

Or, if you have an underlying infection causing pancytopenia, this will be addressed with the appropriate medications. If toxins in your environment are causing your pancytopenia, these will be removed. If an autoimmune disorder or cancer is behind your pancytopenia, then the appropriate treatment plans will be developed.

If your pancytopenia is caused by your cancer treatment, you may need to stop or delay treatment or take growth factor drugs, which stimulate the bone marrow to produce more blood cells. Because these growth factor drugs can have significant side effects, it is important to discuss their use with your healthcare provider.

How to Prevent Pancytopenia

When cancer or an inherited bone marrow disorder is the cause, there is not a lot that can be done to prevent pancytopenia from occurring. However, pancytopenia that stems from nutritional deficiencies—particularly vitamin B12—might be preventable. You can try to get your daily fill of vitamin B12 by eating foods rich in the vitamin, such as meat, poultry, eggs, and dairy products. Fortified breakfast cereals and fortified nutritional yeasts also are good sources of the vitamin.

You also may be able to prevent certain types of infections that can lead to pancytopenia by using good hygiene practices and avoiding close contact with people who are sick. Other  pancytopenia-causing infections may have disease-specific prevention steps. For instance, with HIV, prevention can mean practicing safe sex and not sharing needles.

You also should be aware of any environmental toxins that can lead to pancytopenia and avoid those whenever possible. These include radiation, benzene, and arsenic.

Comorbid Conditions

The comorbidities associated with pancytopenia can include different types of anemia and cancers. Here is an overview of some of the conditions that occur alongside or contribute to pancytopenia:

• Aplastic anemia: Aplastic anemia is a rare but serious condition that occurs when your bone marrow is damaged and cannot make enough new blood cells. Because your body makes fewer red blood cells, white blood cells, and platelets, you can develop pancytopenia.
• Hemolytic anemia: Hemolytic anemia is a blood condition in which your red blood cells are destroyed faster than your body can replace them. While hemolytic anemia does not cause pancytopenia, they can occur alongside one another—particularly in people who have a vitamin B12 deficiency. 
• Splenomegaly: Splenomegaly is an enlarged spleen that can be caused by a number of different conditions, such as infectious mononucleosis. Sometimes when your spleen is enlarged, it will become overactive (hypersplenism) and remove blood cells from your body too quickly, which can lead to pancytopenia in some cases.
• Myelodysplastic syndromes: Myelodysplastic syndromes (MDS) are a type of cancer that can occur when the blood-forming cells in the bone marrow become abnormal. Consequently, one or more blood cells can become low. Because pancytopenia involves all three blood cells becoming low, the two conditions can sometimes occur together, but MDS is an infrequent cause of pancytopenia.

Living With Pancytopenia

In some cases, pancytopenia is mild enough that your healthcare provider may take a wait-and-see approach. In other cases, pancytopenia can be severe and require immediate care. Without treatment, it is possible that pancytopenia can lead to life-threatening symptoms like oxygen shortage and immune system problems.

For those with pancytopenia caused by an environmental toxin, the condition usually resolves as soon as the offending substance is removed from the person’s environment. Likewise, pancytopenia is relatively easy to address when it is related to a nutritional deficiency. But for cases where pancytopenia is caused by cancer or another serious illness or disease, it may take a little longer to reverse and will sometimes be dependent on how quickly the originating condition is resolved.