Cytopenia: Symptoms, Causes, Types, Diagnosis, Treatment & Prevention

 

Low levels of red blood cells (anemia), white blood cells (leukopenia), or platelets (thrombocytopenia) are known as cytopenia. Pancytopenia, or a low level of all your blood cells, is another name for cytopenia. The causes can be acquired or genetic. Treatment may or may not be necessary, depending on the cause.

When one or more of your blood cell types are below normal, you have cytopenia.

Three major components make up your blood. Erythrocytes, another name for red blood cells, transport nutrients and oxygen throughout the body. Leukocytes, or white blood cells, battle harmful bacteria and infections. Clotting depends on platelets. You might develop cytopenia if any of these components are below normal.

Also Read: Anemia: Symptoms, Causes, Diagnosis, Treatment & Prevention

What is cytopenia?

Low levels of specific blood cells are known as cytopenia. Red blood cells, white blood cells, and platelets are the three types of blood cells you have.

Erythrocytes, or red blood cells, transport oxygen to the body's tissues, where cells get their energy.

Leukocytes, or white blood cells, aid in the body's fight against infection. They are important components of your immune system, which defend you against dangerous infections (viruses, bacteria, parasites, and fungi).
Your blood clots because of platelets known as thrombocytes. They prevent excessive bleeding.

What types of cytopenia are there?

Which blood cells have low numbers determines the sort of cytopenia you have.

Low red blood cell counts are referred to as anemia. Your body gets less oxygen when you have anemia.

Low white blood cell counts are referred to as leukopenia. Your risk of infection may rise if your white blood cell count is low. A related disorder known as neutropenia is characterized by decreased neutrophil (white blood cell) counts. Neutrophils make up the majority of your white blood cells.

The term "thrombocytopenia" refers to low platelet counts. Your blood may not clot properly if you have few platelets.

Low levels of all blood cell types are referred to as pancytopenia.

Other categories characterize cytopenia according to its cause:

• When you have an autoimmune condition that makes your immune system target healthy blood cell, you get autoimmune cytopenia. One or more of your blood cells levels are lowered by this attack.

• When your bone marrow can't produce enough blood cells, you have refractory cytopenia. The spongy tissue found inside some bones that makes blood cells is called bone marrow.

Which symptoms of cytopenia are present?

Which blood cells are low, how low your levels are, and the underlying illness producing low blood cell counts all affect your symptoms. Some people are symptom-oblivious. Rather, blood test results inform them of their low levels.


Anemia symptoms include:

• Weakness or fatigue

• Dyspnea, or shortness of breath

• Fast or irregular heartbeat

• Clammy, pale skin

• Chest pain

• Leukopenia/neutropenia symptoms include:

• Fatigue

• Chills and fever

• Throat soreness (pharyngitis)

• Mouth sores

• Severe coughing

• Diarrhea

• Swelling in the lymph nodes

Thrombocytopenia symptoms include:

• Easily bruised

• Severe or protracted bleeding

• Petechiae are marks on your skin caused by bleeding below

Causes:

There are several potential causes for the different types of cytopenia. They usually include issues with your bone marrow's ability to produce blood cells. Another possibility is that you have a disease that breaks down your blood cells after your bone marrow distributes them into your circulation.

Causes can be acquired (something you learn over time) or inherited (something you are born with).

The causes of anemia:

The majority of anemia cases are caused by nutritional inadequacies, particularly iron deficiency anemia. Iron, vitamin B12, and folate are among the elements your bone marrow needs to produce healthy red blood cells. Low counts might result from deficiencies. Anemia can also result from blood loss or disorders that damage your red blood cells.


Anemia-related conditions include:

• Autoimmune diseases

• Diseases of the bone marrow and blood

• Cancer

• Genetic conditions

• Lack of G6PD

• Medication

• Nutrition deficiencies

• Pregnancy

• A lack of pyruvate kinase

• Sickle cell disease

• Thalassemia

Causes of leukopenia/neutropenia:

One of the most frequent reasons for lowered white blood cell counts is cancer treatment, which includes radiation and chemotherapy. These medicines eliminate cancer cells, but as a side effect, they may also kill some healthy cells, such as blood cells.


The following conditions are linked to decreased white blood cell counts:

• Autoimmune diseases

• Disorders of the bone marrow and blood

• Cancer

• Cancer treatments

• Genetic conditions

• Infections

• Medication

• Nutrition deficiencies

The causes of thrombocytopenia:

Thrombocytopenia-related conditions include:

• Disorder of alcohol usage

• Disorders of the autoimmune system, such as immune thrombocytopenia

• Abnormalities of the bone marrow and blood, such as thrombotic thrombocytopenic purpura (TPP)

• Cancer

• Cancer treatments

• Genetic conditions

• Infections

• Heparin-induced thrombocytopenia (HIT) is one of the medications

• Nutrition deficiencies

• Pregnancy

• Exposure to toxic chemicals

Causes of cytopenia that cannot be explained

Occasionally, medical professionals are unable to identify the cause of low blood cell counts. These cytopenias can be divided into two categories:

• Several blood cells with clonal cytopenia of unknown significance (CCUS) have the same acquired genetic mutation (change) in their DNA. Cardiovascular disease and certain blood problems are more likely to occur in people with CCUS.

•  Blood cells with idiopathic cytopenia of unknown significance (ICUS) do not have a genetic mutation in their DNA.

How is the diagnosis of cytopenia made?

A complete blood count (CBC) can reveal whether you have low numbers of platelets, white blood cells, or red blood cells. A common blood test that gives details about your blood cells is a complete blood count (CBC). It tells you how many blood cells you have and gives you details on the features of the cells that could indicate specific diseases.

To find out what is causing your cytopenia, your doctor could run more tests.

What diagnostic procedures will be used to determine the cause of my cytopenia?

The following tests may be used to identify causes:

• Peripheral blood smear: A medical professional applies a sample of your blood to a slide and examines it under a microscope to perform a peripheral blood smear. Possible causes can be inferred from the appearance of the cells.

• Aspiration and biopsy of bone marrow: A medical professional takes a sample of bone marrow and examines it for anomalous cells. These tests can aid in the diagnosis of conditions affecting the blood and bones or cancer.

Additional laboratory testing could be required to identify common causes.

Treatment:

What is the treatment for cytopenia?

Treatment may not be necessary for mild occurrences of cytopenia that are not associated with a serious condition or causing symptoms.

When therapy is required, the underlying ailment causing low levels is typically addressed. For instance, your provider can suggest dietary adjustments or supplements to help you obtain the nutrients you require if a nutritional deficiency is the reason for your low levels. If an infection is the cause of your low levels, you could need antibiotics.

In more serious situations, you might require therapies that immediately boost your cell levels, such as:

• Granulocyte colony-stimulating factor: drugs that cause your neutrophil count to increase. G-CSF is frequently administered to chemotherapy patients to prevent neutropenia.

• Blood transfusion: If your body is unable to manufacture enough blood cells, you may require blood from a donor.

• Bone marrow or stem cell transplant: A transplant substitutes healthy blood cells for the abnormal, immature ones seen in your bone marrow. Eventually, the cells mature into mature blood cells that move through your circulation.

• Splenectomy: Your spleen is removed during a splenectomy. If your spleen is capturing blood cells and removing them from your bloodstream, you might require a splenectomy.

Prevention:

Certain causes, such as cancer, blood and bone marrow problems, and autoimmune diseases, cannot be avoided.

Getting the nutrition your body needs to produce healthy red blood cells can lower your risk of developing some types of cytopenias. For instance, iron deficiency anemia can be avoided by making sure your diet contains enough amounts of iron.

Drinking less alcohol makes it easier for your body to absorb the nutrients it needs to produce healthy blood cells. Low blood counts can be caused by unhealthy alcohol use. By abstaining from alcohol, many of these blood abnormalities can be resolved.

References:

• Justiz Vaillant AA, Zito PM. Neutropenia (https://www.ncbi.nlm.nih.gov/books/NBK507702/). [Updated 2022 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 3/30/2023.

• Bell WR. (2000). Long-term outcome ofsplenectomy for idiopathic thrombocytopenic purpura.https://www.ncbi.nlm.nih.gov/pubmed/10676920

• Chiravuri S, De Jesus O. Pancytopenia (https://www.ncbi.nlm.nih.gov/books/NBK563146/). [Updated 2022 Nov 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 3/30/2023.

• Pancytopenia. (n.d.). https://www.stjude.org/disease/pancytopenia.html

• Turner J, Parsi M, Badireddy M. Anemia (https://www.ncbi.nlm.nih.gov/books/NBK499994/). [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 3/30/2023.

• Jinna S, Khandhar PB. Thrombocytopenia (https://www.ncbi.nlm.nih.gov/books/NBK542208/). [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 3/30/2023.

• Xie Z, Nanaa A, Saliba AN, et al. Treatment outcome of clonal cytopenias of undetermined significance: a single-institution retrospective study (https://pubmed.ncbi.nlm.nih.gov/33649321/). Blood Cancer J. 2021;11(3):43. Accessed 3/30/2023.