Defined as a drop in three blood lines, red blood cells, white blood cells and platelets, pancytopenia has several causes that need to be investigated. The consequences in terms of health are serious with the potential occurrence of anemia, infections and bleeding.

It is by etymological definition a deficit of all the cells present in the blood. In fact, three lines of blood cells are affected:

• red blood cells;
• white blood cells;
• platelets. 

One of the functions of red blood cells is to transport oxygen in the blood, and white blood cells are involved in physiological immunity to fight infections. Platelets are small cells present and involved in blood clotting processes and wound healing.

When these cellular elements are reduced in number, several risk factors appear such as that of anemia (decrease in hemoglobin which carries oxygen in the blood), an infection due to a reduction in immune defenses and blood cells whiteheads (leukopenia), and hemorrhagic phenomena due to the reduction in the number of platelets in the blood (thrombocytopenia).

There are many causes. They can be linked:

• where these cells are made (bone marrow) whose production is reduced or disrupted;
• peripheral causes such as infection (HIV or AIDS for example);
• Vit B12 deficiency (pernicious anemia);
• cancer of the blood and lymph nodes (leukemia or lymphoma) in which the proliferation of white blood cells occurs at the expense of white blood cells and platelets);
• a malfunction of the enlarged spleen (hypersplenism) and no longer its work of storing and repairing red blood cells, white blood cells and platelets;
• drug intoxication (certain antibiotics, colchicine, chemotherapy, phenylbutazone or chemicals (benzene, insecticides, etc.) which can lead to bone marrow depletion;
• premature aging of the bone marrow which no longer produces blood cells (myelodysplasia).

Sometimes the cause is not found.

Symptoms of pancytopenia are related to the reduction in the number of red and white blood cells and platelets. 

The anemia resulting from this reduction in red blood cells is manifested by pallor, intense fatigue due to a lack of oxygen supply in the body’s tissues.

The deficit of white blood cells leads to various infections that are difficult to treat and cure. Finally, the lack of platelets is the cause of various haemorrhages, from the gums, in the urine, in the stools, sometimes in the brain (cranial hematoma) which can be life-threatening.

There are also other symptoms such as the presence of lymph nodes, a large spleen, discomfort with drop in blood pressure, symptoms which are associated with the causes of pancytopenia.

Diagnosis by blood test

The diagnosis of pancytopenia is made by a blood test which looks for the number of red blood cells, white and platelets (Blood Formula Count or CBC), the presence also of cells usually not present in the blood such as large cells (blasts) or blood cells. immature blood cells (erythroblasts…).

Usual figures in an NFS:

• Red blood cells (erythrocytes): between 4 and 6 million;
• White blood cells (leukocytes): between 4000 and 10;
• Platelets: between 150 and 000.

These figures may vary depending on the analysis method used.

Anemia is measured by the level of hemoglobin in the blood (less than 11g / l on average), often associated with a drop in the number of red blood cells.

In pancytopenia, the number of red blood cells is lower than the average, and that of white blood cells too (neutrophils), except in cases of leukemia where it is on the contrary very high, the number of platelets is low, less than 150 (thrombocytopenia), sometimes going below 000 platelets per milliliter of blood.

Diagnosis by myelogram 

Another test is done to understand the cause of pancytopenia: the myelogram.

It will make it possible to confirm a suspicion of blood cancer, to monitor the evolution of a serious anemia, of a thrombocytopenia… This examination is done in the hospital, at the level of the center of the thoracic cage (sternum), in using a syringe, under local anesthesia.

The treatment of pancytopenia will be that of the cause and its consequences. It can be the correction of anemia by blood transfusions, of a hemorrhage by that of platelets, the suppression of an infection by a prescription of antibiotics (antibiotic therapy).

If leukemia or lymphoma are found, treatment will focus on these cancers of the blood and lymph nodes. If it is the spleen that is not functioning well, it is often removed to eliminate the consequences of this dysfunction.

The presence of toxic substances such as drugs or chemical substances will lead to appropriate treatments such as the immediate stopping of the drug or toxic products incriminated, and treatment of their consequences.

Finally, when it is microbes or viruses that are involved, it is the treatment of these microbial or viral diseases that will be implemented.