What Is Pancytopenia?

Medically Reviewed by Zilpah Sheikh, MD on November 09, 2023
5 min read

Your body makes three types of blood cells: red blood cells, white blood cells, and platelets. Pancytopenia is when you have abnormally low amounts of all three. It can be caused by diseases, medicines, or unknown reasons.

Inside your bones, there's a spongy substance called bone marrow, which makes your blood cells. Each type of blood cell has a specific function.

Red blood cells. Your red blood cells have a protein called hemoglobin, which gives them their red color. When you breathe in oxygen, it binds to the hemoglobin and is carried throughout your body. Red blood cells also get rid of carbon dioxide by taking it to your lungs to be exhaled. These make up 44% of your blood.

White blood cells. These are also called leukocytes. They only make up about 1% of your blood. White blood cells protect you from illnesses and diseases. They are always moving through your blood, looking for viruses, bacteria, and other foreign invaders. When they find a threat, they rush in to fight it.

Platelets. Platelets are the smallest of your blood cells. They are shaped like little plates when they're not activated. When a blood vessel is damaged, it sends out a signal to your platelets. Your platelets respond by rushing to the area. They bind with the damaged blood vessel by growing tentacles. This causes your blood to clot.

Pancytopenia happens when you have a combination of three blood disorders:

  • Anemia is when you have too few red blood cells.
  • Leukopenia is when you have too few white blood cells.
  • Thrombocytopenia is when you have too few platelets.

You may not have any symptoms of pancytopenia, or you may have symptoms associated with anemia, leukopenia, or thrombocytopenia.

Anemia. Symptoms of anemia can include:

  • Headaches
  • Cold hands and feet
  • Tiredness
  • Weakness
  • Pale or yellowish skin
  • Shortness of breath
  • Irregular heartbeat
  • Chest pain
  • Dizziness or lightheadedness

Leukopenia. You may not have any symptoms with leukopenia. If you do, they might include:

  • Infection
  • Chills
  • Fever over 100.4 F
  • Sweating

Thrombocytopenia. As thrombocytopenia affects your blood's ability to clot, its symptoms may include: 

  • Bruising easily or a lot
  • Prolonged bleeding from cuts
  • Tiredness
  • Enlarged spleen
  • Nosebleeds
  • Bleeding gums
  • Blood in your urine or stool
  • Heavy menstrual flow

Some symptoms of pancytopenia are serious and need immediate medical care. These include:

  • Loss of consciousness
  • Confusion
  • Fever over 101 F
  • Heavy bleeding
  • Seizures
  • Convulsions
  • Extreme shortness of breath

Many conditions can cause pancytopenia. In about half of all cases, the cause is never found. That is called idiopathic pancytopenia. In some parts of the world, pancytopenia is caused by poor nutrition.

In North America, most cases of pancytopenia are related to an uncontrolled growth of cells. These are known as neoplastic conditions, and they can be cancerous or noncancerous.

Pancytopenia can be due to disorders that cause your bone marrow to make too few blood cells or to disorders that make your body destroy blood cells too quickly. You may have one or both problems.

Some causes of pancytopenia include:

  • Cancer. Cancer cells can enter your bone marrow and lessen the production of healthy cells. Leukemia, lymphoma, and multiple myeloma are just three of the cancers that can cause pancytopenia.
  • Lupus and other autoimmune disorders. Your body's immune cells attack your healthy blood cells.
  • Blood or bone marrow disorders. These include conditions such as aplastic anemia, which causes your bone marrow to make abnormal cells.
  • Viral Infections. HIV, hepatitis C, mononucleosis, and other viral infections can trigger pancytopenia.
  • Side effects of medicine. Some medicines such as antibiotics, blood pressure medication, and heart medication can cause pancytopenia, though this is rare.
  • Exposure to toxins such as radiation, arsenic, or benzine. These can damage your blood cells.
  • Chemotherapy treatments. These suppress the production of healthy blood cells.
  • Radiation treatments
  • Liver disease. Cirrhosis of the liver can allow blood cells to be trapped in your spleen.
  • Drinking too much alcohol. This can lead to liver disease.

Your doctor will listen to your symptoms and ask you about your medical history. They will perform a physical exam. If they think you may have pancytopenia, they may do some other tests, including:

  • A complete blood count, which tells how many blood cells you have of each type
  • A peripheral blood smear, which is when a sample of your blood is examined under a microscope to see if the blood cells are abnormal
  • A test to check your vitamin B12 and folate levels to see if poor nutrition is the cause
  • Tests to check your liver function
  • Tests for infectious diseases
  • A test of your thyroid function
  • A bone marrow biopsy (a small piece of bone marrow tissue from your bones is examined under a microscope for signs of disease)

Treatment for pancytopenia is based on the underlying reason for the condition:

  • Poor nutrition can be fixed through diet.
  • Doctors may tell you to stop taking a certain medication.
  • Doctors will treat any underlying infections that may cause pancytopenia, such as HIV or tuberculosis.
  • If you've been exposed to toxins, they will need to be removed from your environment.

There are several options for treating pancytopenia itself, depending on the cause and the severity of your symptoms. Options include:

  • Stem cell transplant or bone marrow transplant so that your body can have healthy blood cells
  • Medicines that help your bone marrow make more blood cells
  • Blood transfusions to increase the number of red blood cells
  • Medicine that suppresses your immune system if the pancytopenia is due to an autoimmune condition
  • Waiting and monitoring your condition

Once doctors figure out the reason for your pancytopenia and give you the correct treatment, the condition often goes away. But if it's not treated, you could develop complications such as:

  • Increased risk of infections
  • Life-threatening anemia
  • Severe bleeding

If anemia or bleeding happens, you'll need a blood transfusion immediately to increase the number of healthy red blood cells in your body.

How long can you live with pancytopenia?

Pancytopenia itself is not a disease, but it is a sign that you have another condition. How long you can live with it depends on the condition you've been diagnosed with. If it's due to something like poor nutrition, it may go away quickly once you have a proper diet. If it's due to taking a certain chemotherapy drug, it may clear up once you stop taking that drug. If your pancytopenia is not being treated, the length of time you can live with it depends on the nature of your underlying health problem. Treatments such as blood transfusions can help while you're being evaluated.

Pancytopenia is a condition where you have abnormally low amounts of all three types of blood cells -- red, white, and platelets. It can be caused by a disease like cancer, poor nutrition, an immunosuppressive drug, or something unknown. As it is usually a sign or side effect of something else, doctors have to find the reason for your pancytopenia and treat that first.

Is pancytopenia a form of leukemia?

No, pancytopenia can be due to several conditions or diseases. But leukemia is a major cause of pancytopenia because it disrupts the production of red blood cells, white blood cells, and platelets.

Which diseases cause pancytopenia?

It can be a result of many diseases including cancer, lupus, leukemia, aplastic anemia, and hepatitis C.