Most cases of pancytopenia are not related to a hematologic or autoimmune disease, but are attributable to medication. About 15% of cases are caused by chronic iron-deficiency anemia.
Pancytopenia is the most common bone marrow disorder, and can be caused by a wide variety of causes including chemotherapy, chemotherapy immunotherapy, and hematopoietic neoplasms. If you are considering entering a clinical trial for pancytopenia, Power can help you locate clinical trial reports. Finally, if you have symptoms of pancytopenia, [elderly(s)] (see Healthy people above) [elderly(s) and palliative medicines] can help you find recent trials of potential treatment for pancytopenia.
In selected cases, it is tempting to propose a policy of "wait and see" or even a policy of "do not treat." [No chemotherapy in our case] can be justified by the following rationale. As a consequence of chemotherapy, the risk of bone marrow transplant (allo-BMT), specifically a graft versus host disease, has to be avoided. In general, patients who fail to respond to chemotherapy have a much higher risk of developing BMT, as illustrated by the 5% of patients who will develop BMT in our case, whereas this is zero for those who respond to chemotherapy. In fact, the cumulative incidence of BMT may be overestimated for these "nonresponders".
Inpatient therapy or observation for acute, transient pancytopenia is appropriate. For all other forms of pancytopenia, treatment may include red blood cell transfusions or a stem cell transplant for myelodysplastic syndromes and acute leukemias.
Although it may be hard to differentiate in the medical field from many other causes, this is not surprising. Pancytopenia is diagnosed frequently in the field of general medicine. It can be caused by a number of different conditions, including immune-mediated disorders, anemia, and some medications and chemicals. The most common cause in pediatric patients is infections, such as mumps and the Epstein-Barr virus. In adults, it is the result of various autoimmune diseases, some cancers, and viral infections, such as HIV/AIDS.
The most common sign of pancytopenia is anemia. In the setting of chronic disease, this can take several weeks to present clinically, but can be found in individuals with an otherwise healthy immune system and can be reversible as pancytopenia can be the result of cytokine toxicity from the immunosuppressive agents being used to treat the underlying illness.
A significant proportion of the population studied, regardless of family history, had severe pancytopenia and a reduced ability to mount an erythropoietic response to erythropoietin deficiency.
It is not uncommon for healthy individuals to have pancytopenia at the age of 70 or 65 years. No individual should be worried about pancytopenia until age 75. For anyone younger, we urge clinicians to screen for aplastic anemia and/or pancytopenia in individuals under the age of 70.
The common side effects of donor derived g-csf are anemia, thrombin time elevation, and epistaxis. These are rarely severe. It seems that G-CSF must be used cautiously in patients suffering from clotting disorders and anticoagulation should be routinely employed when G-CSF is used for the mobilization of pbc.
The most common indications were myelodysplastic syndromes, myeloproliferative neoplasms, and acute leukemia. Most of the agents used had no FDA approval, and their use in chronic lymphocytic leukemia (CLL) has been controversial. Nevertheless their use in CLL has been shown to result in prolonged and/or increased survival. There is not sufficient evidence to suggest that they are effective in treating pancytopenia patients, even in selected cases: (i) CLL patients with low cytogenetic and/or immunophenotypical aberrancies or (ii) younger pancytopenic patients who fail to respond to conventional therapy or are deemed inexpendable for conventional therapy.
In a recent study, findings demonstrate the therapeutic potential of this approach, and highlight the potential advantages compared with current conventional regimens using high doses of corticosteroids.
Pancytopenia is not extremely uncommon following SCT with a median time of occurrence of 20 months. Most of the cases occurred in the early period of SCT and resolved themselves. However, some might have taken longer to resolve. Thus, if any clinical problem ensues, it might be wise to get a bone marrow examination.