Table of ContentsView AllTable of ContentsAbout MyelosuppressionSymptomsCausesBlood Cell DeficienciesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
About Myelosuppression
Symptoms
Causes
Blood Cell Deficiencies
Diagnosis
Treatment
Coping
Myelosuppression, or bone marrow suppression, is defined as a decrease in the ability of the bone marrow to produce blood cells. This may result in a lack of red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).
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Hematopoiesis, Bone Marrow, and Myelosuppression
To understand myelosuppression it’s helpful to talk about the function of bone marrow. In the bone marrow, all of the blood cells—red blood cells, white blood cells, and platelets—begin with a single cell type: thehematopoieticstem cell.
Hematopoietic stem cells can evolve into any type of blood cell. These cells go down separate pathways as they differentiate into red blood cells, platelets, and white blood cells, and then into more specialized cells such as the different types of white blood cells. But they all begin with stem cells.
What Is Myelosuppression?Myelosuppression is decreased bone marrow activity. Something interferes or disrupts stem cells and results in fewer of all types of blood cells.
What Is Myelosuppression?
Myelosuppression is decreased bone marrow activity. Something interferes or disrupts stem cells and results in fewer of all types of blood cells.
The term “myeloablation” refers to severe myelosuppression in whichnoblood cells are made.
Cells Affected in Myelosuppression
Myelosuppression can result in decreased production of:
Red Blood Cells (RBCs)
Red blood cells contain hemoglobin, the protein that is responsible for binding with and delivering oxygen to all of the tissues of the body.
White blood cells (WBCs)
White blood cells are part of the immune system and fight against microorganisms such as bacteria, viruses, and fungi.
Platelets
Platelets are responsible for helping blood to form a clot. They stick together to stop bleeding when a blood vessel is broken (e.g. a cut or bruise).
What Is the Difference Between Myelosuppression and Immunosuppression?With myelosuppression, the production of white blood cells decreases, so there will beimmunosuppression.However, immunosuppression doesn’t always mean myelosuppression. For example, a medication (or another process) may suppress white blood cells or other particular parts of the immune system, but not affect the red blood cells or platelets.
What Is the Difference Between Myelosuppression and Immunosuppression?
With myelosuppression, the production of white blood cells decreases, so there will beimmunosuppression.However, immunosuppression doesn’t always mean myelosuppression. For example, a medication (or another process) may suppress white blood cells or other particular parts of the immune system, but not affect the red blood cells or platelets.
With myelosuppression, the production of white blood cells decreases, so there will beimmunosuppression.
However, immunosuppression doesn’t always mean myelosuppression. For example, a medication (or another process) may suppress white blood cells or other particular parts of the immune system, but not affect the red blood cells or platelets.
Pancytopenia
The symptoms of myelosuppression depend on the underlying cause, the level of deficiency of blood cells, and more.
Low red blood cell counts can lead to:
Since red blood cells carry oxygen in the blood to different parts of the body, a low number can also cause symptoms similar to blood vessel obstruction, such as angina.
Low white blood cell counts raise the risk of infections. Symptoms are primarily those related to the different types of infections such as:
Low platelet counts can result in bleeding. Symptoms may include:
There are several ways in which the bone marrow can be disrupted so that it does not produce blood cells, but these can be broken down into three major categories:
Regardless of the method, the result is that fewer blood cells are formed. Sometimes the cause of myelosuppression is very obvious, such as when a person is receiving chemotherapy; sometimes it is much less clear, and further tests are needed to determine which category is involved and the specific disorder.
Damage to Stem Cells
The most common cause of myelosuppression is medications that slow the ability of stem cells and specialized descendants to divide and multiply. All of our blood cells are continuously being replenished.
Medications such as chemotherapy drugs cause drug-induced bone marrow suppression. Chemotherapy kills off all rapidly dividing cells such as cancer cells, but also damages or kills stem cells that become all types of blood cells.
This type of myelosuppression is usually reversible if the medication causing myelosuppression is stopped.
Disrupting Blood Cell Production
Viruses that have been linked to myelosuppression include:
Replacement of the Bone Marrow/Bone Marrow Crowding
Cancers that can result in “crowding” include:
Bone Marrow Failure
Deliberate myelosuppression/myeloablation is sometimes used as a cancer treatment. In blood-related cancers present in the bone marrow, very high dose chemotherapy is used to ablate the bone marrow.
When the bone marrow is “clear” abone marrow transplantor peripheral blood stem cell transplant is then done to repopulate the bone marrow with healthy, noncancerous cells.
When stem cells aren’t growing and dividing and specializing into the unique types of blood cells (when there is bone marrow suppression or myelosuppression), deficiencies in the type of blood cells are called:
The diagnosis of myelosuppression will depend on many factors. In the case of chemotherapy-induced myelosuppression, the cause is often obvious. In other cases, a careful history, physical exam, and imaging studies will likely be done, but laboratory analysis is often the mainstay of diagnosis.
Laboratory analysis may include the following:
A number of other tests may be done to further clarify any findings or look for causes.
The treatment of myelosuppression includes addressing the underlying cause(s), raising levels of blood cells when needed, and treating symptoms related to the deficiencies.
Treatment of Underlying Causes
Treating the underlying cause, when possible, can often resolve the abnormalities, but may take time.
Treatment of Low Blood Counts
For symptoms related to myelosuppression, treatments may be directed at the specific cell deficiency causing symptoms.
If chemotherapy is being used, treatment may need to be delayed until blood counts are restored to adequate levels.
Sometimes low blood counts do not require treatment, yet there are still things you can do to lower your risk. These lifestyle measures are helpful even if your low counts are being treated.
For anemia, actions you can take include:
For leukopenia, actions you can take to avoid infection include:
For thrombocytopenia, actions you can take include:
Keep in mind that some over-the-counter medications (such as aspirin) and dietary supplements (such as melatonin,echinacea, ginkgo biloba, and other herbal remedies) may increase bleeding time as well.Talk with your healthcare provider before starting any dietary supplements.
Summary
Myelosuppression is a condition where the bone marrow produces fewer red blood cells, white blood cells, and platelets. There are several causes with chemotherapy treatment being the most common.
Determining the cause is important in figuring out the best treatment options. Work with your healthcare provider to understand your diagnosis and determine the best treatment options for you.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Myelosuppression.Blood Cancer UK.Blood cells.Penn Medicine.What is anemia?Aplastic Anemia and MDS International Foundation.What are the symptoms of low blood counts?Crawford J, Herndon D, Gmitter K, et al.The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol. 2024;20(21):1515-1530. doi: 10.2217/fon-2023-0513Pascutti MF, Erkelens MN, Nolte MA.Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front Immunol. 2016 Sep 16;7:364. doi: 10.3389/fimmu.2016.00364Canadian Cancer Society.Low blood cell counts.Leukemia Foundation.Primary myelofibrosis.Dana Farber Cancer Institute.Types of stem cell transplant.Hatfield J, Saad S, Housewright C.Dietary supplements and bleeding. Proc (Bayl Univ Med Cent). 2022 Sep 15;35(6):802-807. doi: 10.1080/08998280.2022.2121575Additional ReadingKeohane, E. M., Otto, C. N., Walenga, J. M., & Rodak, B. F. (2019).Rodaks hematology: clinical principles and applications. Philadelphia: Saunders.Rodak’s Hematology: Clinical Principles and Applications, 6th Edition. Saunders. 2019.Weinzierl E, Arber D.The Differential Diagnosis and Bone Marrow Evaluation of New-Onset-Pancytopnia.American Journal of Clinical Pathology. 2013. 139(1):9-29. doi:10.1309/AJCP50AEEYGREWUZ
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Myelosuppression.Blood Cancer UK.Blood cells.Penn Medicine.What is anemia?Aplastic Anemia and MDS International Foundation.What are the symptoms of low blood counts?Crawford J, Herndon D, Gmitter K, et al.The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol. 2024;20(21):1515-1530. doi: 10.2217/fon-2023-0513Pascutti MF, Erkelens MN, Nolte MA.Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front Immunol. 2016 Sep 16;7:364. doi: 10.3389/fimmu.2016.00364Canadian Cancer Society.Low blood cell counts.Leukemia Foundation.Primary myelofibrosis.Dana Farber Cancer Institute.Types of stem cell transplant.Hatfield J, Saad S, Housewright C.Dietary supplements and bleeding. Proc (Bayl Univ Med Cent). 2022 Sep 15;35(6):802-807. doi: 10.1080/08998280.2022.2121575Additional ReadingKeohane, E. M., Otto, C. N., Walenga, J. M., & Rodak, B. F. (2019).Rodaks hematology: clinical principles and applications. Philadelphia: Saunders.Rodak’s Hematology: Clinical Principles and Applications, 6th Edition. Saunders. 2019.Weinzierl E, Arber D.The Differential Diagnosis and Bone Marrow Evaluation of New-Onset-Pancytopnia.American Journal of Clinical Pathology. 2013. 139(1):9-29. doi:10.1309/AJCP50AEEYGREWUZ
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Cancer Institute.Myelosuppression.Blood Cancer UK.Blood cells.Penn Medicine.What is anemia?Aplastic Anemia and MDS International Foundation.What are the symptoms of low blood counts?Crawford J, Herndon D, Gmitter K, et al.The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol. 2024;20(21):1515-1530. doi: 10.2217/fon-2023-0513Pascutti MF, Erkelens MN, Nolte MA.Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front Immunol. 2016 Sep 16;7:364. doi: 10.3389/fimmu.2016.00364Canadian Cancer Society.Low blood cell counts.Leukemia Foundation.Primary myelofibrosis.Dana Farber Cancer Institute.Types of stem cell transplant.Hatfield J, Saad S, Housewright C.Dietary supplements and bleeding. Proc (Bayl Univ Med Cent). 2022 Sep 15;35(6):802-807. doi: 10.1080/08998280.2022.2121575
National Cancer Institute.Myelosuppression.
Blood Cancer UK.Blood cells.
Penn Medicine.What is anemia?
Aplastic Anemia and MDS International Foundation.What are the symptoms of low blood counts?
Crawford J, Herndon D, Gmitter K, et al.The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol. 2024;20(21):1515-1530. doi: 10.2217/fon-2023-0513
Pascutti MF, Erkelens MN, Nolte MA.Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front Immunol. 2016 Sep 16;7:364. doi: 10.3389/fimmu.2016.00364
Canadian Cancer Society.Low blood cell counts.
Leukemia Foundation.Primary myelofibrosis.
Dana Farber Cancer Institute.Types of stem cell transplant.
Hatfield J, Saad S, Housewright C.Dietary supplements and bleeding. Proc (Bayl Univ Med Cent). 2022 Sep 15;35(6):802-807. doi: 10.1080/08998280.2022.2121575
Keohane, E. M., Otto, C. N., Walenga, J. M., & Rodak, B. F. (2019).Rodaks hematology: clinical principles and applications. Philadelphia: Saunders.Rodak’s Hematology: Clinical Principles and Applications, 6th Edition. Saunders. 2019.Weinzierl E, Arber D.The Differential Diagnosis and Bone Marrow Evaluation of New-Onset-Pancytopnia.American Journal of Clinical Pathology. 2013. 139(1):9-29. doi:10.1309/AJCP50AEEYGREWUZ
Keohane, E. M., Otto, C. N., Walenga, J. M., & Rodak, B. F. (2019).Rodaks hematology: clinical principles and applications. Philadelphia: Saunders.
Rodak’s Hematology: Clinical Principles and Applications, 6th Edition. Saunders. 2019.
Weinzierl E, Arber D.The Differential Diagnosis and Bone Marrow Evaluation of New-Onset-Pancytopnia.American Journal of Clinical Pathology. 2013. 139(1):9-29. doi:10.1309/AJCP50AEEYGREWUZ
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