At a Glance

Bone marrow suppression is defined by a decrease in bone marrow hematopoietic cells leading to peripheral cytopenias. Patients may exhibit fatigue, pallor, dyspnea on exertion, tachycardia due to anemia, and easy bruising or mucocutaneous bleeding due to thrombocytopenia. Patients may also present with infections due to leukopenia. Bone marrow suppression is most commonly because of drug effects, such as are seen with cytotoxic chemotherapy or some immunosuppressive medications. Infectious agents, especially viruses, can also suppress hematopoiesis.

What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?

A complete blood count (CBC) with differential should be ordered to confirm the presence of cytopenias.

Bone marrow biopsy will reveal a hypocellular marrow, although these findings are nonspecific. Some viral infections, such as parvovirus B19 and cytomegalovirus, may exhibit characteristic morphologic features in the bone marrow.(Table 1)

Continue Reading

Table 1.
Hemoglobin Platelet count Absolute neutrophil count
<10 g/dL <100×109/L <1.5×109/L

Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?

It is important to correlate laboratory findings with the patient history and other clinical data. Bone marrow suppression is most commonly seen after administration of cytotoxic chemotherapy or immunosuppressive medications, such as azathioprine. So, a complete drug history is critical.

Evidence of viruses should also be sought, especially in the presence of specific signs and symptoms of infection or in immunosuppressed patients. Viruses that may cause bone marrow suppression include hepatitis viruses, parvovirus B19, human immunodeficiency virus (HIV), cytomegatovirus (CMV), and Epstein-Barr virus (EBV), among others. (See chapters for these individual viruses for testing information.)

Cytopenias are a nonspecific finding. Thus, other causes of bone marrow failure should be considered and ruled out, such as aplastic anemia, medication effects, including cytotoxic chemotherapy and drug-induced neutropenia, toxic insults, autoimmune disorders, and bone-marrow replacement. In younger patients, congenital bone marrow failure syndromes, such as Fanconi’s anemia, dyskeratosis congenita, and Shwachman-Diamond syndrome, might be considered. Myelodysplastic syndrome should be in the differential diagnosis for older patients or those with a history of cytotoxic chemotherapy.

What Lab Results Are Absolutely Confirmatory?

Cytopenias by CBC in the context of bone marrow suppressing drugs or infection is confirmatory, although other causes should be considered and ruled out.