Pancytopenia

Simultaneous leukopenia, nonregenerative anemia, and thrombocytopenia; not a disease itself - rather, a group of laboratory findings that can result from multiple causes.

By Tilley, Larry P. ; Smith, Francis W.K. ; Sleeper, Meg M. ; Brainard, Benjamin M. in Blackwell's Five-Minute Veterinary Consult: Canine and Feline

overview
basics
diagnosis
treatment
medication
follow-up

Overview

Pancytopenia is a medical condition characterized by the simultaneous presence of leukopenia (low white blood cell count), nonregenerative anemia (a type of low red blood cell count), and thrombocytopenia (low platelet count). It is important to note that pancytopenia is not a disease itself but rather a set of laboratory findings that can result from various underlying causes. This condition can affect dogs and cats of any age, sex, or breed and typically arises due to factors such as decreased production of blood cells in the bone marrow, increased destruction or use of blood cells in the peripheral circulation, or the sequestration of cells in specific organs.

Pancytopenia requires a thorough diagnostic evaluation, including bone marrow examination and blood tests, to identify the underlying cause, which can include infections like FeLV, FIV, parvovirus, and anaplasmosis. Treatment involves addressing the specific clinical situation, including supportive measures such as aggressive antibiotic therapy and blood transfusions. Medication should be carefully chosen based on the clinical context, and it is essential to avoid drugs that may suppress blood cell production or trigger immune-mediated destruction. Follow-up care includes daily examinations, temperature monitoring, and periodic complete blood counts to monitor the patient's progress. The prognosis for pancytopenia depends on the underlying cause and may often be guarded.

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Symptoms
Lethargy, Petechial hemorrhage, Repeated febrile episodes
Causes
FeLV, FIV, parvovirus, anaplasmosis
Diagnosis
Bone marrow examination, blood tests, underlying conditions
See the full list
Treatments
Antibiotic therapy and blood transfusions
See the full list
Medication
Should be appropriate for the clinical situation; see specific causes.
See the full list
Follow-up
Daily examination, monitoring of body temp, periodic CBC
See the full list

Basics

Pathophysiology: Mechanisms may include decreased production of cells in the bone marrow or increased peripheral use, destruction, or sequestration; one or more of these mechanisms may occur together.

Decreased production occurs when pluripotent, multipotent, or committed stem cells are destroyed, their proliferation or differentiation is suppressed, or the maturation of differentiated cells is delayed or arrested.

If pluripotent stem cells are affected, pancytopenia develops; if committed stem cells are involved, cytopenia of the specific cell type develops.

Increased use and destruction of cells typically results in increased production in the bone marrow. At least 2–3 days are required before increased production begins to have an effect on peripheral blood cell counts, and peak output usually takes about a week; thus, the rate of use or destruction necessary to cause cytopenia is not as great during the first few days of disease as it is later.

Sequestration of cells in the microcirculation, especially that of the spleen, intestine, and lungs, can cause cytopenia of the cell type involved.
Systems Affected: Hemic/lymphatic/immune—bone marrow, spleen, lymph nodes, and other lymphocytic tissues; depending on the cause, these organs can be affected by cellular depletion, degeneration, necrosis, hyperplasia, dysplasia, or dyscrasia; changes may occur alone or in combination.
Incidence/Prevalence: Pancytopenia is an uncommon occurrence and does not always occur with the causes listed (see Causes). The incidence is reported as 2.4% in dogs and 2.8% in cats.
Geographic Distribution: Unless the cause of pancytopenia is an infectious agent that is localized to a certain region (e.g., leishmaniasis, histoplasmosis), no specific geographic distribution exists.
Signalment: Dogs and cats.

No age, sex, or breed predilection.
Risk Factors: Vary with individual cause

Diagnosis

Signs

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Causes

Tests

Treatment

Supportive treatment depends on the clinical situation and includes aggressive antibiotic therapy and blood component transfusions.

Treatment of the underlying condition is paramount.

View potential underlying conditions

Medication

Drug(s) of choice

Treatment should be appropriate for the clinical situation (i.e., the degree to which each cell population is decreased, presence of fever or infection, and established or suspected specific diagnoses); see specific causes.

Contradictions

Drugs that may suppress hematopoiesis or trigger immune‐mediated destruction (see Causes). Nonsteroidal anti‐inflammatory drugs, clopidogrel, or other drugs that may interfere with platelet function if thrombocytopenia present.

Precautions

Because of the patient’s potentially compromised immune status, glucocorticoids and other immunosuppressive drugs should be used only when necessary (e.g., when an immune component is suspected) and with extreme care and frequent monitoring.

Alternative drug(s)

Recombinant Hematopoietic Growth Factors: Recombinant human granulocyte colony‐stimulating factor (rhG‐CSF) 1–5 μg/kg/day SC; stimulates neutrophil production, may result in development of antibodies against endogenous G‐CSF. Recombinant human erythropoietin (rhEPO)—initial dosage 100 U/kg SC, 3 times/week; stimulates erythropoiesis, may result in development of antibodies against endogenous EPO, darbepoetin may also be considered.

Follow-up

Patient monitoring
- Daily physical examination, including frequent monitoring of body temperature.
- Periodic CBC—frequency depends on severity of cytopenia, age, general physical condition of the patient, and underlying cause.
Prevention/Avoidance
- Castration of cryptorchid males (to prevent development of a Sertoli or interstitial cell tumor).
- Vaccination for infectious diseases.
- Frequent monitoring of CBC in cancer patients receiving chemotherapy or radiation therapy.
Possible complications
- Hemorrhage.
- Sepsis.
Expected course and prognosis
- Depends on the underlying cause.
- Often a guarded prognosis is warranted.
Zoonotic potential
- Tularemia, if this is the underlying cause.
- An owner can contract histoplasmosis from the same source as the patient.
Pregnancy/fertility/breastfeeding
Stress of underlying disease may cause abortion; see respective topics for the effects of different causes on pregnancy.

Pancytopenia

Overview

Symptoms

Causes

Diagnosis

Treatments

Medication

Follow-up

Basics

Diagnosis

Signs

Causes

Tests

Treatment

Medication

Drug(s) of choice

Contradictions

Precautions

Alternative drug(s)

Follow-up

Patient monitoring

Prevention/Avoidance

Possible complications

Expected course and prognosis

Zoonotic potential

Pregnancy/fertility/breastfeeding

Suggested Reading

Related conditions

Abbreviations

Recent articles from European Bioinformatics Institute

Presumptive hemophagocytic syndrome associated with co-infections with FIV, Toxoplasma gondii, and Candidatus mycoplasma haemominutum in an adult cat.

Toxic cause for feline pancytopenia cases.

A feline case of multiple myeloma treated with bortezomib.