Bone Marrow Failure

Overview

Bone marrow failure is a condition in which the bone marrow, the spongy tissue inside bones that produces blood cells, cannot make enough healthy cells. Normally the marrow produces red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help blood clot. When the marrow fails, the levels of one or more of these cell types fall, sometimes all at once, a state called pancytopenia.

The effects depend on which cells are low: too few red cells cause anemia and fatigue, too few white cells raise the risk of infection, and too few platelets cause easy bruising and bleeding. Bone marrow failure can be acquired, for example from immune attack, toxins, or another disease, or inherited through genetic conditions present from birth. Treatment ranges from supportive care to medications and, in some cases, bone marrow (stem cell) transplant.

Symptoms

Symptoms reflect which blood cells are low and how severely. They can include:

• From low red cells (anemia): fatigue, weakness, pale skin, shortness of breath, and a fast heartbeat
• From low white cells: frequent or severe infections and fevers
• From low platelets: easy bruising, tiny red spots on the skin, nosebleeds, bleeding gums, and prolonged bleeding from minor cuts

Symptoms may come on gradually or, in some forms, more quickly. Seek emergency care for heavy or uncontrolled bleeding, a high fever with signs of serious infection, or sudden severe shortness of breath or chest pain. A fever in someone with very low white cells is a medical emergency.

Causes

Bone marrow failure has many causes, broadly divided into acquired and inherited. They include:

• Aplastic anemia: often an immune attack on the marrow, sometimes triggered by drugs, toxins, or infection.
• Myelodysplastic syndromes: the marrow makes abnormal, poorly functioning cells.
• Chemotherapy and radiation: which suppress the marrow.
• Toxins and certain medications: including some chemicals and drugs.
• Infections: some viral infections can affect the marrow.
• Cancers that invade the marrow: such as leukemia or spread from other cancers.
• Inherited disorders: genetic conditions such as Fanconi anemia, usually appearing in childhood.

Risk Factors

Risk factors depend on the underlying cause and include:

• Treatment with chemotherapy or radiation
• Exposure to certain industrial chemicals or toxins
• Use of some medications linked to marrow suppression
• Certain viral infections
• A family history of inherited marrow failure syndromes
• Other blood or autoimmune disorders

Diagnosis

Diagnosis involves confirming low blood counts and finding the cause. Tests usually include:

• Complete blood count (CBC): to measure red cells, white cells, and platelets.
• Blood smear: to examine the cells under a microscope.
• Bone marrow biopsy and aspiration: a key test that shows how well the marrow is producing cells and whether abnormal cells are present.
• Genetic testing: to identify inherited marrow failure syndromes, especially in younger patients.
• Additional tests: for infections, vitamin deficiencies, and immune causes.

These tests guide both the diagnosis and the choice of treatment.

Treatment

Treatment depends on the cause, severity, and the person's age and overall health. It combines supportive care with treatments aimed at the underlying problem. Options include:

• Supportive care: blood and platelet transfusions, and prompt antibiotics for infections.
• Growth factor medications: to stimulate the marrow to produce more cells in some cases.
• Immune-suppressing therapy: for immune-mediated forms such as aplastic anemia.
• Treating the underlying cause: stopping a responsible drug or treating an infection or cancer.
• Bone marrow (stem cell) transplant: can be a curative option for selected patients, especially younger people with severe disease.

Because of infection and bleeding risks, careful monitoring and infection precautions are an important part of care.

Prevention

Many cases of bone marrow failure cannot be prevented, but some risks can be reduced and complications limited. Helpful steps include:

• Avoiding unnecessary exposure to toxic chemicals such as benzene and certain solvents
• Using protective equipment when working with hazardous materials
• Taking medications only as prescribed and reporting unusual symptoms
• Following infection-prevention measures, such as good hand hygiene, if blood counts are low
• Attending regular follow-up and blood-count monitoring
• Considering genetic counseling if inherited marrow failure runs in the family

When to See a Doctor

See a doctor if you have ongoing fatigue, frequent infections, or easy bruising and bleeding, or if a blood test shows low blood counts. Early evaluation helps identify the cause and start appropriate treatment.

Seek emergency care immediately for heavy or uncontrolled bleeding, a fever with signs of serious infection (especially if your white cells are known to be low), sudden severe shortness of breath, chest pain, or signs of bleeding in the brain such as a sudden severe headache, confusion, or weakness.

Related Topics

Frequently Asked Questions

References

1. National Heart, Lung, and Blood Institute (NHLBI). Aplastic Anemia.
2. MedlinePlus, U.S. National Library of Medicine. Bone marrow diseases.
3. National Organization for Rare Disorders (NORD). Acquired Aplastic Anemia.
4. National Cancer Institute (NCI). Myelodysplastic Syndromes.