Cytopenia

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Treatment

Anemia
People with anemia (reduced red cell production) are advised to rest and eat foods high in iron (meat, fish, poultry, lentils, legumes, iron-enriched grains and flours).

If immediate remedy is necessary, treatment may include medication that helps restore the red blood supply and a transfusion of packed red blood cells.

Epoetin alpha (Epogen®, Procrit®)is a synthetic erythropoietin (normally produced by the kidneys) that stimulates stem cells to produce red blood cells. Restoration of the red blood cell supply with medication is gradual.

Darbepoetin alfa (Aranesp®) also stimulates red blood cell production but requires fewer doses and less disruption of daily living.

In March 2007, the Food and Drug Administration (FDA) issued a warning about these medications in response to studies indicating that they may increase the risk for blood clots, strokes, and heart attacks in some patients (e.g., patients who have kidney disease).

Thrombocytopenia
People with an abnormally low platelet count should avoid bruising or breaking the skin, and should carefully brush their teeth. A persistently decreased platelet count may be treated with a transfusion of platelets.

Neutropenia
The patient with a low white blood cell count is advised to:

• avoid contact with people who are ill,
• monitor closely for signs of infection (e.g., fever), and
• take antibiotics when appropriate.

Medication, a colony-stimulating factor (CSF), may be prescribed to speed the development of white blood cells and shorten the period of susceptibility to infection.

Growth Factors
Growth factors are synthetic versions of substances involved in stimulating red and white blood cell production. Physicians exercise caution when prescribing these medications for people with tumors that involve the bone marrow, because growth factors might stimulate malignant cell growth.

These medications include the following:

• Epoetin alpha (Procrit®, Epogen®; stimulates red blood cell production)
• G-CSF (granulocyte colony-stimulating factor; e.g., filgrastim [Neupogen®]; stimulates neutrophil production)
• GM-CSF (granulocyte-macrophage colony-stimulating factor; stimulates production of several white blood cells, including macrophages)

Leukocytes and other cells that contain granules are also called granulocytes.

Side effects
Fever, fatigue, dizziness, diarrhea, nausea, vomiting, weakness, and paresthesia (prickling sensation) are side effects associated with epoetin alpha.

Bone pain, malaise, headache, flu-like symptoms, muscle ache, redness at the injection site, and skin rash may occur with GM-CSF.

G-CSF commonly produces bone pain.

Bone Marrow and Stem Cell Transplantation
The treatment of choice for the pancytopenic patient with a matched bone marrow donor is stem cell transplantation. The goal of transplantation is to restore blood-forming stem cells to the marrow.

Immunosuppressive Therapy
When a compatible bone marrow donor cannot be found, immunosuppression is the treatment of choice for patients with pancytopenia.

Antilymphocyte globulin (ALG) or antithymocyte globulin (ATG) combined with cyclosporine is given. Improvement in blood counts is slow, taking a couple of months, and relapse is common. Follow-up includes an annual bone marrow examination.

Side effects—Flu-like symptoms and joint pain are common early side effects of ALG and ATG. Long-term treatment with cyclosporine can cause hypertension, seizures, opportunistic infections, and nephrotoxicity (poisoning of the kidney).

Prognosis

Anemia, thrombocytopenia, and neutropenia caused by cancer treatment usually resolve once the course of treatment is over.

Pancytopenia patients who receive a marrow transplant from a matched donor also have a good prognosis for recovering satisfactory cell counts. Recipients of marrow from imperfectly matched donors are at high risk for complications caused by the transplant. Survival rates of patients who receive immunosuppressive therapy are similar to those who receive transplants.

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