Bone Marrow Disorders
When the body's blood-cell factory malfunctions
Quick Facts
- Type: Blood and bone marrow disorders
- Main effect: Abnormal blood cell production
- Possible signs: Fatigue, infections, easy bruising
- Diagnosis: Blood tests and marrow biopsy
Overview
Bone marrow is the spongy tissue inside bones where blood cells are made, including red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help blood clot. Bone marrow disorders are a group of conditions in which this production goes wrong, either making too few cells, too many, or abnormal cells.
These disorders range from temporary problems to serious, long-term diseases such as aplastic anemia, myelodysplastic syndromes, and blood cancers like leukemia. Symptoms often relate to a shortage of one or more blood cell types. Diagnosis usually requires blood tests and an examination of the marrow itself, and treatment depends on the specific disorder.
Symptoms
Symptoms depend on which blood cells are affected and whether the marrow is making too few or too many.
- Low red cells (anemia): Fatigue, weakness, pale skin, shortness of breath, and dizziness
- Low white cells: Frequent or severe infections and fevers
- Low platelets: Easy bruising, prolonged bleeding, nosebleeds, or tiny red skin spots
- Overproduction: Some disorders cause too many cells, leading to clotting problems, headaches, or an enlarged spleen
- Unexplained weight loss, night sweats, or bone pain in some conditions
Symptoms may come on gradually or, in some disorders, more quickly.
Causes
Bone marrow disorders have many causes, and sometimes no cause is identified.
- Genetic and inherited conditions: Some marrow failure disorders are present from birth.
- Acquired damage: Certain medications, chemotherapy, radiation, toxins, or viral infections can harm the marrow.
- Autoimmune processes: The immune system may mistakenly attack marrow cells.
- Cancers of the blood and marrow: Such as leukemia and myelodysplastic syndromes, where abnormal cells crowd out normal ones.
- Nutritional deficiencies: Severe lack of certain vitamins can impair blood cell production.
Risk Factors
- Previous chemotherapy or radiation treatment
- Exposure to certain industrial chemicals or toxins
- Some viral infections
- Autoimmune conditions
- Inherited marrow failure syndromes or a family history
- Older age for some disorders such as myelodysplastic syndromes
Diagnosis
Diagnosis combines blood testing with a direct look at the marrow.
- Complete blood count: Measures levels of red cells, white cells, and platelets and is often the first clue.
- Blood smear: Examining cells under a microscope to spot abnormal shapes or types.
- Bone marrow aspiration and biopsy: Taking a small sample of marrow to examine how cells are being produced.
- Specialized tests: Genetic and chromosome studies help identify specific disorders and guide treatment.
Treatment
Treatment is highly specific to the disorder and its severity.
- Supportive care: Blood or platelet transfusions and treatment of infections to manage symptoms.
- Medications: Drugs that stimulate blood cell production, suppress an overactive immune system, or treat the underlying disease.
- Chemotherapy: Used for blood cancers and some other marrow disorders.
- Bone marrow or stem cell transplant: Can be curative for certain severe disorders by replacing diseased marrow with healthy stem cells.
- Treating the cause: Stopping a responsible medication or correcting a severe nutritional deficiency where applicable.
Care is usually directed by a hematologist, a specialist in blood disorders, and is tailored to the individual diagnosis.
Prevention
Many bone marrow disorders cannot be prevented, especially inherited or unexplained ones. Some general measures may lower risk or support early detection:
- Limit unnecessary exposure to known marrow-damaging chemicals and radiation
- Use protective equipment when working with industrial toxins
- Attend recommended follow-up blood tests if you have had chemotherapy or radiation
- Report ongoing fatigue, frequent infections, or easy bruising to a doctor for early evaluation
When to See a Doctor
See a doctor for persistent fatigue, frequent or severe infections, easy bruising or bleeding, or unexplained pale skin, as these can reflect a problem with blood cell production. Early evaluation with a blood count can help identify the cause.
Seek urgent care for heavy or uncontrollable bleeding, a high fever with a known low white cell count, severe shortness of breath, or signs of a serious infection, since people with bone marrow disorders can become seriously ill quickly and may need prompt treatment.
Frequently Asked Questions
What does the bone marrow do?
Bone marrow is the tissue inside bones that makes blood cells: red cells that carry oxygen, white cells that fight infection, and platelets that help blood clot. Bone marrow disorders disrupt this production, affecting one or more of these cell types.
Are all bone marrow disorders cancer?
No. Some are cancers, such as leukemia or myelodysplastic syndromes, but others, like aplastic anemia, are not cancer. They are grouped together because they all involve a problem with how the marrow makes blood cells.
How are bone marrow disorders diagnosed?
They usually start with a blood count that shows abnormal cell levels. A definitive diagnosis often requires a bone marrow biopsy, in which a small sample of marrow is examined, sometimes along with genetic tests.
Can a bone marrow disorder be cured?
Some can. Certain severe disorders can be cured with a bone marrow or stem cell transplant, while others are managed long-term with supportive care and medications. The outlook depends heavily on the specific diagnosis.
When should I seek urgent care?
Get urgent care for heavy or uncontrollable bleeding, a high fever (especially with a low white cell count), severe shortness of breath, or signs of serious infection. People with marrow disorders can become very ill quickly.
References
- National Heart, Lung, and Blood Institute (NHLBI). Aplastic Anemia and Bone Marrow Failure.
- Leukemia & Lymphoma Society. Bone Marrow and Blood.
- MedlinePlus, U.S. National Library of Medicine. Bone marrow diseases.