What is Cytopenia & How is it Treated?
What is Cytopenia?
Cytopenia is a collection of pathological conditions which is usually found in patients with cancer. This condition is characterized by abnormally low cellular elements of blood as a result of a myriad of physical disorders. These cells stop to grow normally in patients with Cytopenia. Cytopenia ranges from a variety of blood disorders which could be seriously damaging the overall health of the patient and can potentially be fatal without a timely diagnosis.
What are the Different Types of Cytopenia?
Normally, blood has three types of cells which are the red blood cells or the RBCs, the white blood cells or the WBCs, and the platelets. If there is a reduction in production of any of these types of cells it may result in a variety of blood disorders like the following:
Anemia: This is a condition in which there is less production of RBCs. The main function of the RBCs is to supply oxygen to various parts of the body and to vital organs of the body. If there is reduced production of RBCs, then the organs will receive less oxygen than is required for them to function adequately resulting in them malfunctioning and causing host of illnesses.
Leukopenia: This is a condition in which there is reduced count of the WBCs or the white blood cells. The white blood cells are used to fight off infections or invasion of any foreign body like a bacteria or a virus. Hence if there is a reduced count of WBCs, then the patient will be prone to infections and other illnesses.
Neutropenia: This is a condition in which there is reduced production of neutrophils which are used by WBCs to fight off infections and illnesses. A reduced count of neutrophils again puts the patient at risk for frequent infections and illnesses, especially bacterial infections.
Thrombocytopenia: This is a condition in which there are less platelets formed by the bone marrow. Platelets are essential for clotting and bleeding. A low platelet count may increase the risk of profuse bleeding even with a minute injury and easy bruising and it will take an awful lot of time for clotting process to take place.
Pancytopenia: This is a type of cytopenia in which there is a reduced count of all types of blood cells meaning there is low count of RBCs, WBCs, and platelets and is far more dangerous than the above mentioned conditions.
What are the Causes of Cytopenia?
Some of the causes of Cytopenia are:
Iron Deficiency: An individual with less iron in the body is prone to reduced RBCs as iron is what is required by the bone marrow to produce red blood cells. Anemia is the most common disorder caused by low intake of iron in the food.
Alcoholism: An individual who abuses alcohol puts the bone marrow at risk for becoming toxic leading to decreased production of blood cells.
Radiation Therapy: This therapy is used in cancer patients where high energy rays are used to destroy cancer cells. Reduced production of white blood cells is one of the side effects of radiation therapy.
Medications: There are also certain medications that can cause Cytopenia. These medications are used to treat seizures, malaria, and HIV. Certain antibiotics like penicillin also can cause Cytopenia. Prolonged use of medications like phenytoin, indomethacin, chlorpromazine can cause neutropenia. Antipsychotic, anticonvulsant, and immunosuppressive drugs can cause leukopenia. Platelet count can be affected by taking excess of Valproic acid and methotrexate.
Vitamin Deficiencies: Decreased intake of vitamin B12 and folic acid may result in decreased production of blood cells in the bone marrow.
Hereditary Conditions: Certain hereditary conditions like Alport syndrome, Wiskott–Aldrich syndrome can result in development of Cytopenia.
Autoimmune Conditions: Autoimmune disorders are also a causative factor for development of Cytopenia.
Bone Marrow Disorders: Disease conditions like leukemia or lymphoma can affect the production of blood cells in the bone marrow. Another disease condition like myelodysplastic disorder is also a causative factor in development of Cytopenia.
Viral Infections: Infections like HIV, hepatitis C, varicella, rubella, mumps are some of the infections that affect the bone marrow and hence affect the production of blood cells resulting in Cytopenia.
What are the Symptoms of Cytopenia?
The symptoms of Cytopenia have been subdivided into the symptoms of each of the condition that constitute Cytopenia. These symptoms are:
Neutropenia: Symptoms include frequent infections and illnesses, including bacterial, viral, or fungal infections, fever, and ulcers in the mouth and throat.
Thrombocytopenia: Symptoms include easy bleeding, easy bruising, increased clotting time, spontaneous bleeding especially in the nose and mouth. There may also be purple colored rashes on the skin.
Pancytopenia: Symptoms include easy bleeding and bruising, fatigue, lethargy, weakness, failure to do even simple household tasks, spontaneous bleeding especially in the gums and nose.
How is Cytopenia Diagnosed?
The methods used for diagnosing Cytopenia are:
CBC: This will tell the exact count of the number of red blood cells, white blood cells, and platelets in the blood and if there is any reduction then it may indicate towards Cytopenia.
Bone Marrow Aspiration and Biopsy: Once Cytopenia is suspected then the physician may recommend a bone marrow aspiration and biopsy. A small needle is inserted into the bone marrow and a sample is withdrawn and sent for analysis. An abnormality in the testing will point towards a diagnosis of Cytopenia.
How is Cytopenia Treated?
For treating Cytopenia it is extremely important to know the cause of the condition and the severity of it. If anemia is the cause for the condition then the patient will be asked to take foods rich in iron content to increase iron in the body like meat, fish and the like. The following methods are used to treat people with Cytopenia:
Medical Approach for Treating Cytopenia: In order to restore the production of RBCs in the body a synthetic erythropoietin named epoetin alpha is recommended. Steroids are used for treating autoimmune thrombocytopenia. In severe cases of Cytopenia IVIG is used. In order to increase the platelet count corticosteroids and folate can be recommended. Vitamins are suggested for bone marrow disorders.
Plasmapheresis: This is a technique in which plasma is replaced with albumin or saline solution so as to prevent an autoimmune attack.
Blood Transfusion: This is done so that the RBC count increases and the symptoms of Cytopenia become less. This is usually done for those patients who have abnormally low levels of RBCs.
Bone Marrow and Stem Cell Transplantation: In this technique, the stem cells that have the potential to develop into specialized cells like blood cells are taken from a healthy patient and infused into the patient’s bone marrow so as to replace the damaged cells with new healthy cells.
Bone Marrow Stimulators: Bone marrow stimulators can also be used so that the bone marrow produces increased blood cells. Some of the medications used for stimulating the bone marrow are procrit, neupogen, and leukine.
What is the Prognosis for Cytopenia?
Coming to the prognosis of Cytopenia, anemia, thrombocytopenia, and neutropenia which are caused by cancer treatment resolve once the treatment is stopped or the course is over. Individuals with Pancytopenia have a good prognosis if they undergo a marrow transplant but the donor and the recipient should be matched or else the transplant may give rise to further complications.
Cytopenia may be a complex disorder but it is treatable and even preventable provided the exact cause of the condition is known. Some people with Cytopenia may require regular blood transfusions while others may just be perfectly fine with cause-specific treatments, although post treatment regular monitoring will be required for patients to look at the levels of blood and see the status of Cytopenia.