Cytopenia

Description, Causes and Risk Factors:

In medicine, the word cyto refers to a cell, and penia means low or decreased. A cytopenia therefore, is a disorder characterized by low or decreased levels of one or more blood components in the circulation. Blood has several components including the RBCs (red blood cells), platelets, and WBCs (white blood cells). RBCs are cells that deliver oxygen and nutrients to all parts of the body. Platelets are important in blood clotting, and WBCs act to defend the body against infections.

Types May Include:

A cytopenia that shows a deficiency in the amount of RBC in the circulation is known as anemia. Anemia is usually caused by other underlying diseases that result in bleeding, increased destruction of RBC in the circulation, and abnormal production of RBC by the bone marrow.

• Low WBC in the circulation is called leukopenia. This type of cytopenia is frequently caused by infections such as malaria, influenza, and tuberculosis. Some forms of cancer, such as leukemia and Hodgkin's lymphoma also present with low WBC count. The most common cause of this form of cytopenia, however, is due to cancer treatments such as chemotherapy and radiation therapy.

• Low or reduced platelet count is known as thrombocytopenia. Thrombocytopenia is usually caused by other underlying conditions, such as bone marrow cancer and chronic liver disease, which lead to the decreased production of platelets. It may also result from the increased destruction of platelets in the circulation, such as seen in cases of dengue hemorrhagic fever (DHF) and chemotherapy treatment.

Causes and Risk Factors:

Chemotherapy and radiation therapy both reduce the number of blood-forming stem cells in cancer patients, but chemotherapeutic agents have a greater adverse effect because they suppress bone marrow function in several ways. The degree of damage is related to the particular drugs and the dose. Chemotherapeutic agents can produce deficiencies in all blood cell types by damaging blood-forming stem cells, suppressing the kidneys' production of erythropoietin (hormone that stimulates blood cell production), and triggering red cell destruction (hemolysis) by inducing an immune response that causes the body to mistakenly identify erythrocytes as foreign bodies and destroy them.

Malignant tumors can also causes cytopenias when they directly invade bone marrow and suppress marrow function. Malignant cells also can migrate from tumors in other parts of the body to bone marrow. Tumors also can replace normal blood-forming stem cells with abnormal clones.

There are many reports stating that in the course of viral infections, cytopenias particularly leucopenia and thrombocytopenia may develop due to autoimmune inhibition and/or inhibition at the level of precursor cells in the bone marrow. Apart from viral agents like hepatitis B and C viruses which cause marked cytopenia, there are also viral infections causing severe cytopenia like parvovirus B19 and HIV. Leucopenia is known to occur frequently in the course of influenza A infections, but isolated thrombocytopenia, anemia and pancytopenia are rare. There are few reports stating that the new influenza A (H1N1) may cause cytopenias.

Symptoms:

Symptoms include poor concentration, weakness, palpitations or increased heart rate, and shortness of breath during exertion.

• Patients with leukopenia may present with headache, weakness, and fever, and they are more prone to catch infections easily.

Other common symptoms may include:

Headache.

• Lightheadedness.

• Confusion.

• Dizziness.

• Loss of concentration.

• Pallor (pale skin, nail beds, gums, linings of eyelids).

• Rapid heart rate (tachycardia).

• Shortness of breath (dyspnea).

Diagnosis:

Diagnosis of cytopenia often requires a complete blood count (CBC) and the identification of any blood and bone marrow abnormalities.The CBC (complete blood count) is a blood test often requested by physicians to evaluate the presence of cytopenia in ill patients. The CBC shows the value of WBC, platelets, and RBC in a blood sample.

RBC is the number of red blood cells capable of carrying hemoglobin in a cubic millimeter of blood. The normal RBC for men is 4.5 to 6 million cubic millimeter; for women, 4 to 5.5 million per cubic millimeter. Reticulocyte (young red blood cell) are also counted.

WBC is the total number of all five types of white blood cells. The normal WBC for men and women is 5,000 to 10,000 per milliliter of blood.

Five types of cells are counted and then reported as a percentage of the WBC. This is called the differential. (Mast cells are not included because they are not present in the blood.) Typical reports show the normal range:

Eosinophils 1-4%.

• Lymphocytes 20-40%.

• Basophils < 1%.

• Monocytes or macrophages 2-8%.

• Neutrophils 55-70%.

• The normal platelet count ranges from 150,000 to 450,000 platelets per milliliter of blood.

Other Tests May Include:

Bone marrow aspiration and biopsy.

• Needle biopsy.

Treatment:

General Treatment Options:

People with reduced red cell production are advised to rest and eat foods high in iron (meat, fish, poultry, lentils, legumes, iron-enriched grains and flours). If immediate remedy is necessary, treatment may include medication that helps restore the red blood supply and a transfusion of packed red blood cells.

• The patient with a low white blood cell count is advised to: avoid contact with people who are ill, monitor closely for signs of infection (e.g., fever), and take antibiotics when appropriate.

• Medication, a colony-stimulating factor (CSF), may be prescribed to speed the development of white blood cells and shorten the period of susceptibility to infection.

• People with an abnormally low platelet count should avoid bruising or breaking the skin, and should carefully brush their teeth. A persistently decreased platelet count may be treated with a transfusion of platelets.

Other Treatment Options May Include:

Bone marrow and stem cell transplantation.

• Immunosuppressive therapy.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.