Bone marrow suppression

For congenital bone marrow suppression click here.
For acquired bone marrow suppression click here.

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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

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
• Dexrazoxane
• Ethosuximide
• Fludarabine
• Hydroxyurea (patient information)
• Idarubicin hydrochloride
• Ixabepilone
• Mercaptopurine
• Mitomycin
• Mitoxantrone
• Omacetaxine
• Romidepsin
• 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.

References

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