pancytopenia

Pancytopenia is defined by simultaneous decreases in red blood cells, white blood cells, and platelets. Clinically it presents with anemia symptoms such as fatigue, pallor; increased infection risk due to leukopenia; and bleeding or bruising from thrombocytopenia. Pancytopenia is a finding rather than a specific disease, and its significance depends on the underlying cause, the severity of cytopenias, and the rate of onset.

Causes fall into three broad categories: decreased marrow production, increased destruction or sequestration, and combined effects. Decreased production includes aplastic anemia, myelodysplastic syndromes, leukemias, marrow infiltration, and drug- or toxin-induced damage. Nutritional deficiencies (vitamin B12 or folate) can contribute to cytopenias. Hypersplenism or autoimmune processes may sequester or destroy cells, and some infections such as parvovirus B19 or HIV can transiently suppress marrow.

Evaluation begins with a complete blood count and peripheral smear, with reticulocyte count to gauge marrow response. If cytopenias persist, a bone marrow examination is often required to distinguish production failure from destruction or infiltration. Additional tests may include vitamin B12 and folate levels, iron studies, liver and renal function, viral serologies, autoantibodies, and imaging to assess splenomegaly or marrow involvement.

Management aims at the underlying cause and supportive care. Transfusion and infection control are used as indicated. Treatment is disease-specific: immunosuppressive therapy or transplant for aplastic anemia; disease-directed therapy for myelodysplastic syndromes or leukemia; avoidance of causative drugs. Nutritional supplementation is indicated for deficiencies. Prognosis depends on the cause, patient age, and response to therapy, with earlier diagnosis improving outcomes.