Bone marrow suppression: Difference between revisions
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'''''For congenital bone marrow suppression click [[congenital bone marrow disorders#Inherited Bone Marrow Failure Syndromes|here]].'''''<br> | |||
'''''For acquired bone marrow suppression click [[acquired bone marrow disorders#Bone Marrow Suppression|here]].'''''<br> | |||
'''''For the main page of bone marrow disorders click [[bone marrow disorders|here]].''''' | |||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{YD}}; {{Rim}}; {{SSK}} | ||
{{SK}} Bone marrow failure, bone marrow depression, myelosuppression, myelosuppressive disorder | {{SK}} Bone marrow failure, bone marrow depression, myelosuppression, myelosuppressive disorder | ||
==Overview== | ==Overview== | ||
Bone marrow suppression is the reduction in numbers of cells in bone marrow, that can be either congenital or acquired. Acquired bone marrow suppression may be any of the following: 1) myelosuppression | Bone marrow suppression is the reduction in numbers of cells in the [[bone marrow]], that can be either congenital or acquired. Acquired bone marrow suppression may be any of the following: 1) myelosuppression characterized by a reduction in the number of [[myeloid]] lineage cells ([[RBC]], [[neutrophils]], [[basophils]], [[eosinophils]], [[monocyte]]s, [[platelets]], [[mastocytes]]), or 2) immunosuppression characterized by a reduction in the number of [[lymphoid]] lineage cells ([[T-cell]], [[B-cell]], [[NK cell]]). Bone marrow suppression can be a serious side effect of [[chemotherapy]] and certain drugs affecting the immune system such as [[azathioprine]]. [[NSAID]]s may also cause bone marrow suppression. The risk is especially high in chemotherapy for [[leukemia]]. | ||
==Classification== | ==Classification== | ||
Shown below is an algorthim that depicts the classification of bone marrow suppression. For congenital bone marrow suppression click [[congenital bone marrow disorders#Inherited Bone Marrow Failure Syndromes|here]]. For acquired bone marrow suppression click [[acquired bone marrow disorders#Bone Marrow Suppression|here]]. | |||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree |boxstyle= padding: 0; background: #DCDCDC; | | | | | | | | | | | | | |,| D01 | | | | | | | | D01= [[Myelodysplasia]]}} | {{Family tree |boxstyle= padding: 0; background: #DCDCDC; | | | | | | | | | | | | | |,| D01 | | | | | | | | D01= [[Myelodysplasia]]}} | ||
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{{Family tree | | | | | | | | | |!| | | |!| | | | | | | | | | }} | {{Family tree | | | | | | | | | |!| | | |!| | | | | | | | | | }} | ||
{{Family tree |boxstyle= padding: 0; background: #DCDCDC; | | | | | | | | | |!| | | |`| D03 | | | | | | | | D03= [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]])}} | {{Family tree |boxstyle= padding: 0; background: #DCDCDC; | | | | | | | | | |!| | | |`| D03 | | | | | | | | D03= [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]])}} | ||
{{Family tree |boxstyle= padding: 0; background: #66CDAA; | | | | | |,| B01 |(| | | | | | | | | | | | | | | B01= | {{Family tree |boxstyle= padding: 0; background: #66CDAA; | | | | | |,| B01 |(| | | | | | | | | | | | | | | B01= Myelosuppression}} | ||
{{Family tree |boxstyle= padding: 0; background: #A9A9A9; | | | | | |!| | | |!| | | |,| D04 | | | | | | | | D04= [[Pure red cell aplasia]] ([[erythroblastopenia]])}} | {{Family tree |boxstyle= padding: 0; background: #A9A9A9; | | | | | |!| | | |!| | | |,| D04 | | | | | | | | D04= [[Pure red cell aplasia]] ([[erythroblastopenia]])}} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | | | | | | | | }} | {{Family tree | | | | | |!| | | |!| | | |!| | | | | | | | | | }} | ||
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* [[Cyclophosphamide]] | * [[Cyclophosphamide]] | ||
* [[Dactinomycin]] | * [[Dactinomycin]] | ||
* [[Daunorubicin liposome]] | |||
* [[Dexrazoxane]] | * [[Dexrazoxane]] | ||
* [[Diethylpropion]] | |||
* [[Ethosuximide]] | * [[Ethosuximide]] | ||
* [[Fludarabine]] | * [[Fludarabine]] | ||
* [[Guanidine]] | |||
* [[Hydroxyurea (patient information)]] | * [[Hydroxyurea (patient information)]] | ||
*[[Idarubicin hydrochloride]] | * [[Idarubicin hydrochloride]] | ||
*[[Ixabepilone]] | * [[Imipenem-Cilastatin]] | ||
* [[Ixabepilone]] | |||
* [[Mercaptopurine]] | * [[Mercaptopurine]] | ||
* [[Mitomycin]] | * [[Mitomycin]] | ||
* [[Mitoxantrone]] | * [[Mitoxantrone]] | ||
* [[Omacetaxine]] | * [[Omacetaxine]] | ||
* [[Procarbazine]] | |||
* [[Radium chloride]] | |||
* [[Romidepsin]] | * [[Romidepsin]] | ||
* [[Samarium (153Sm) lexidronam]] | |||
* [[Sulfasalazine]] | * [[Sulfasalazine]] | ||
*[[Teniposide]] | *[[Teniposide]] | ||
| Line 59: | Line 72: | ||
* [[Zidovudine]] | * [[Zidovudine]] | ||
==Natural History, Complications | ==Natural History, Complications and Prognosis== | ||
The [[bone marrow]] is where blood cells are formed, and this process is slowed or stopped when bone marrow suppression is caused. This can rapidly lead to life-threatening [[infection]] as the body cannot produce [[leukocytes]] in response to invading [[bacterium|bacteria]] and [[viruses]], as well as anemia due to a lack of [[red blood cells]] and spontaneous severe bleeding due to deficiency of [[platelets]]. | The [[bone marrow]] is where blood cells are formed, and this process is slowed or stopped when bone marrow suppression is caused. This can rapidly lead to life-threatening [[infection]] as the body cannot produce [[leukocytes]] in response to invading [[bacterium|bacteria]] and [[viruses]], as well as anemia due to a lack of [[red blood cells]] and spontaneous severe bleeding due to deficiency of [[platelets]]. | ||
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==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Immunology]] | [[Category:Immunology]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 14:51, 17 August 2015
For congenital bone marrow suppression click here.
For acquired bone marrow suppression click here.
For the main page of bone marrow disorders click here.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Rim Halaby, M.D. [2]; Serge Korjian M.D.
Synonyms and keywords: Bone marrow failure, bone marrow depression, myelosuppression, myelosuppressive disorder
Overview
Bone marrow suppression is the reduction in numbers of cells in the bone marrow, that can be either congenital or acquired. Acquired bone marrow suppression may be any of the following: 1) myelosuppression characterized by a reduction in the number of myeloid lineage cells (RBC, neutrophils, basophils, eosinophils, monocytes, platelets, mastocytes), or 2) immunosuppression characterized by a reduction in the number of lymphoid lineage cells (T-cell, B-cell, NK cell). Bone marrow suppression can be a serious side effect of chemotherapy and certain drugs affecting the immune system such as azathioprine. NSAIDs may also cause bone marrow suppression. The risk is especially high in chemotherapy for leukemia.
Classification
Shown below is an algorthim that depicts the classification of bone marrow suppression. For congenital bone marrow suppression click here. For acquired bone marrow suppression click here.
| Myelodysplasia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| All hematopoietic lineages | Aplastic anemia (aplastic pancytopenia) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paroxysmal nocturnal hemoglobinuria (PNH) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myelosuppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pure red cell aplasia (erythroblastopenia) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| One lineage | Neutropenia (granulocytopenia and agranulocytosis) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acquired bone marrow suppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amegakaryocytic thrombocytopenia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| T-cell immunosuppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Immunosuppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| B-cell immunosuppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bone Marrow Suppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| NK cell immunosuppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple lineages | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Congenital bone marrow suppression | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| One lineage | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Causes
Drug Side Effects
- Albendazole
- Altretamine
- Bosutinib
- Cladribine
- Cyclophosphamide
- Dactinomycin
- Daunorubicin liposome
- Dexrazoxane
- Diethylpropion
- Ethosuximide
- Fludarabine
- Guanidine
- Hydroxyurea (patient information)
- Idarubicin hydrochloride
- Imipenem-Cilastatin
- Ixabepilone
- Mercaptopurine
- Mitomycin
- Mitoxantrone
- Omacetaxine
- Procarbazine
- Radium chloride
- Romidepsin
- Samarium (153Sm) lexidronam
- Sulfasalazine
- Teniposide
- Thioguanine
- Zidovudine
Natural History, Complications and Prognosis
The bone marrow is where blood cells are formed, and this process is slowed or stopped when bone marrow suppression is caused. This can rapidly lead to life-threatening infection as the body cannot produce leukocytes in response to invading bacteria and viruses, as well as anemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets.
Treatment
Bone marrow suppression due to azathioprine can be treated by changing to another medication such as mycophenolate mofetil (for organ transplants) or other disease-modifying drugs in rheumatoid arthritis or Crohn's disease. Bone marrow suppression due to anti-cancer chemotherapy is much harder to treat and often involves hospital admission, strict infection control, and aggressive use of intravenous antibiotics at the first sign of infection.