Cytopenia is a common condition that cancer patients are found to develop. Get detailed information on this blood disorder, including its types, symptoms, causes, diagnosis, and treatment.
It does not refer to a single ailment but an umbrella term for a wide spectrum of fatal disorders. It is characterized by an abnormal deficiency of the cellular elements of blood due to the presence of a host of physical disorders. The normal production of these cells tends to cease in an affected patient. It is sometimes denoted as “Hypocytosis”.
It comprises of a diverse range of hematological or blood disorders that could be damaging to the health of patients in the absence of timely diagnosis.
Under normal circumstances, the blood comprises of three forms of cells that include:
- Erythrocytes or Red blood cells (RBCs)
- Leukocytes or White blood cells (WBCs)
Deficiency of any of these blood cells can give rise to the following forms:
RBCs are the most common type of blood cells. They carry important protein chemical called hemoglobin that contains iron. Their primary function is to supply oxygen to the various tissues in the body from the lungs. In this condition, the RBC count is less than normal. It is essentially caused by either a decrease in the production of erythrocytes or an increase in destruction of the cells.
WBCs, also known as Leukocytes, constitute the immunity system of the body by protecting it against different forms of infection. They also eliminate the damaged or dead tissues completely from the body. Leukocytes are divided into five classes based on the morphological features and include:
This particular form is manifested by a low number of WBCs that puts an individual at a high risk of infection by weakening the immune system.
Granulocytes are a category of leukocytes filled with microscopic granules that contain enzymes for digesting infectious microorganisms entering the body. These harmful minute organisms are engulfed through a process called phagocytosis. Neutrophils, eosinophils and basophils are all types of granulocytes.
It is marked by an abrupt reduction in the number of neutrophil granulocytes that are actually the most abundant type of WBCs in the blood. Increased susceptibility to bacterial infections depends upon the presence or absence of bone marrow- producers of neutrophils.
Platelets, which play an essential role in clotting and bleeding, are produced in the bone marrow. The disorder is characterized by a lower than normal number of the cells. Low platelet count may cause profuse bleeding during an injury and there is usually a delay in the clotting process.
There is a shortage of all the types of blood cells, including RBCs, WBCs and platelets. The condition can lead to anemia, leukopenia or thrombocytopenia.
The symptoms are classified according to the several types of the disorder that are as follows:
Fatigue is the most common sign of the condition. The other symptoms include:
- Lack of concentration
- Pallor or paleness of skin
- Rapid heart beat
- Shortness of breath
Vulnerability to infections leads to a host of health problems like:
- Stomach cramps
- Heavy and prolonged menstrual period
- Oral ulcers
Neutropenic patients generally experience a number of infections of the skin, gastrointestinal tract and urinary tract. These infections may lead to various problems, such as:
- Painful urination
- Unusual redness
- Throat pain
- Mouth ulcers
- Acute swelling around a wound
Affected patients with a deficiency of platelets may easily get injured and bleed spontaneously in areas like mouth, nose, colon or vagina. Some of the symptoms include:
- Pin head-size, red and flat spots under the skin
- Increased bleeding during menstrual period
- Rashes or bruises
The condition is not generally manifested by any unique symptoms and could be a consequence of other disorders. However, some of its typical features include:
- Increased susceptibility to fungal infections
- Sore throat
- Bleeding gums
- Fever and chills
It may develop at a slower or faster pace and can progress in several ways. The condition usually displays generalized conditions like:
- Easy bruising or rash
- High fever
- Difficulty in breathing
Nearly all the forms of cytopenia have the same set of causes. The severity of the ailment is directly linked to the percentage of the blood cells that are damaged in the bone marrow. This occurs due to reasons like:
Iron is the major constituent required for making RBCs in the bone marrow. Limited intake or inadequate amount of this element may lead to anemia.
It can lead to the toxicity of the bone marrow and reduce the production of the blood cells.
High-energy rays are frequently used to destroy the cancer cells in affected patients. However, it may also produce a number of side effects such as a decrease in the number of WBCs.
Drugs that are used for the treatment of seizure, HIV and malaria may often lead to a deficiency of erythrocytes. Some antibiotics like penicillin and chloramphenicol as well as antifungal medications may prove fatal to the individuals.
Regular use of flecainide, phenytoin, indomethacin, propylthiouracil, carbimazole and chlorpromazine may initiate development of neutropenia. Antipsychotic, anticonvulsant and immunosuppressive drugs are the major determinants of leukopenia. Excess intake of Valproic acid, Methotrexate, Carboplatin and Interferon can alter the platelet count.
Low amount of vitamin B12 or folic acid in the body can affect the production of the blood cells in the bone marrow.
Bernard-Soulier syndrome, Grey platelet syndrome, Alport syndrome, Wiskott–Aldrich syndrome are some of the causative factors of thrombocytopenia. Individuals who are having a family history of blood disorders may develop pancytopenia. Cyclic neutropenia is marked by a low neutrophil count due to inherited mutations.
Sometimes, organ transplantation and blood transfusion can disturb the immune system giving rise to thrombocytopenia.
Kostmann syndrome is a rare autosomal form of disorder giving rise to severe chronic neutropenia.
Destruction of neutrophils may also be a result of an autoimmune disorder or a drug that stimulates the immune system. Connective tissue disorders can cause platelet destruction due to an autoimmune response.
Bone marrow disorders
Blood cancers such as leukemia or lymphomas can alter the production of red blood cells in the bone marrow, causing anemia or thrombocytopenia. Myelodysplastic syndrome or MDS is a group of disorders marked by abnormal development of one or more cell lines that are normally found in the bone marrow. Refractory cytopenia with multilineage dysplasia is a typical form of MDS, causing frequent infections due to the presence of defective blood cells.
HIV, hepatitis C, varicella, rubella, mumps and parvovirus are some of the common infections, affecting the bone marrow, which in turn lower the platelet count. Neutropenia is caused by a number of bacterial or parasitic infections like tuberculosis, malaria and Epstein Barr virus.
Abnormalities in the bone marrow as well as a thorough analysis of the components of the blood may help health care providers diagnose the condition. The most common medical techniques include:
Complete blood count (CBC)
This blood test is regularly done to evaluate the cellular elements of blood. In a CBC, the number of WBCs, RBCs or platelets is measured. White blood cell differential count is also performed in order to calculate the several types of WBCs. The presence of the disorder is highlighted by a low blood cell count.
Bone marrow aspiration and needle biopsy
In this procedure, a special needle is inserted into the bone marrow and a small sample is withdrawn by suction for further examination of the fluid. Low blood count reveals infection or a serious disorder of the bone marrow. Most often the marrow is obtained from the pelvic or breast bone.
It is essential for physicians to know the cause and severity of the disorder for the proper application of the various treatment procedures. Anemic patients are advised to follow a diet, comprising of foods that are rich in iron like meat, fish, lentils, or legumes. The following methods may help an affected patient make an early recovery from the disorder.
A synthetic erythropoietin called epoetin alpha can be taken by patients to restore the production of RBCs. Autoimmune thrombocytopenia can be treated with steroids. Severe cases may require intravenous immunoglobulins (IVIG) or antibodies to inhibit the immune reaction. Platelet count can also be increased by corticosteroids, lithium carbonate or folate. Vitamins are also given to treat bone marrow disorders. A colony-stimulating factor can also be administered to induce higher production of WBCs.
The liquid portion of the blood accounts for half the volume of blood and contains several antibodies and proteins. However, the same antibodies turn detrimental to the body during an autoimmune reaction. This particular technique is often used to replace the plasma with saline solution or albumin. This is done to remove its components to reduce the attack on a patient’s own body.
This process of transferring compatible blood or cellular elements is generally carried out in adverse cases. A quick transfusion is essential to increase blood cell count that has drastically dropped to a very low level.
Bone Marrow and Stem Cell Transplantation
It is a new technique that is lately being implemented in many health care centers. In this process, the stem cells that have a potential to develop into specialized cell types (such as liver or blood cells) are used. The healthy cells are taken from the blood or bone marrow of a donor and introduced into a patient’s marrow to replace the damaged ones. In this way, the supply of healthy blood-forming cells in the body is replenished.
Although Cytopenia is a complicated disorder, it is curable and preventable if its cause is known. Some individuals may require immediate and specific treatments, whereas others can be treated through occasional blood transfusion. Post-therapy, regular monitoring of the blood cell levels is always beneficial in preventing the reoccurrence of the disorder in patients.