Depending on the patient, bone marrow insufficiency may be due to a variety of causes. Some forms of bone marrow insufficiency are curable with the help of appropriate therapeutic steps.
What is bone marrow insufficiency?
In the context of bone marrow insufficiency, those cells in the bone marrow that are responsible for the formation of blood are disturbed or significantly reduced in an affected person. Corresponding bone marrow cells can be divided into red blood cells, white blood cells, and platelets. Depending on the form that bone marrow atrophy takes in an individual, the aforementioned blood-forming bone marrow cells are each affected by degradation to varying degrees. Bone marrow loss, which occurs as a symptom of so-called aplastic anemia (a form of anemia), for example, affects the entirety of all blood-forming cells of the bone marrow – in corresponding patients, these bone marrow cells are completely absent. Bone marrow insufficiency in the context of such anemia is expressed in the affected person, for example, by possible symptoms such as pallor of the skin, general weakness, shortness of breath and/or palpitations. If only the platelets are affected by bone marrow loss, the insufficiency may be manifested, for example, by hematomas (skin bleeding).
Causes
In comparatively rare cases, bone marrow insufficiency may be a symptom of forms of anemia that are already congenital. In most cases, however, bone marrow loss is acquired during life:
For example, exposure to toxins such as benzene can cause atrophy of blood-forming bone marrow cells. Various infections caused by pathogens such as viruses and bacteria are also a possible cause of bone marrow insufficiency. Another causative factor of bone marrow atrophy is exposure of the human body to radioactive radiation; such radiation may be released, for example, during radiation therapy or accidents involving radioactivity. Finally, in addition to bone marrow tumors, which may promote bone marrow insufficiency, various drug administrations also carry the risk of promoting bone marrow atrophy – relevant drugs include, for example, agents used in the course of chemotherapy.
Symptoms, complaints, and signs
If bone marrow insufficiency is based on congenital anemia, characteristic signs of the disease occur, such as fatigue, shortness of breath, and cardiovascular complaints. Symptoms such as palpitations, recurrent dizziness and concentration problems are also typical. Those affected generally feel very unwell and their performance is sometimes severely restricted. Externally, the disease is manifested by skin pallor and eye rims, and weight loss may also occur. Comparable signs occur in the non-congenital form. In parallel, ulcers develop on the skin. The bruises often appear even with slight pressure and subsequently persist for a longer period of time. The above-mentioned symptoms may indicate various ailments. One clear symptom is anemia, which usually accompanies the underlying condition. If the bone marrow dysfunction is treated professionally, the symptoms usually subside. The disease is unlikely to heal on its own. Without therapy, the signs of the disease become more severe and cause complications such as fainting or bedriddenness. Bleeding on the skin can be reliably treated. However, in severe disease, scars or sensory disturbances remain. If internal organs have already been damaged by the insufficiency, late effects may still occur years later.
Diagnosis and course
A suspected diagnosis of bone marrow insufficiency may initially be made based on the appearance of described symptoms in an affected individual. A diagnosing physician can usually derive further clues from a patient’s medical history. Finally, to confirm the presence of bone marrow insufficiency, microscopic examination of an affected person’s blood sample is often performed. Bone marrow smears can also help to confirm the diagnosis of bone marrow failure under microscopic examination.The course of bone marrow insufficiency in a given patient depends primarily on the cause of the disease; if bone marrow loss is caused by underlying diseases such as anemia, for example, independent recovery is comparatively rare. The course of bone marrow insufficiency can often be positively favored by early and expert control of underlying factors.
Complications
In most cases of bone marrow insufficiency, various complaints occur. Those affected suffer from very severe anemia. This can lead to general weakness and pallor, and in the process significantly reduce the resilience of the affected person. It is also not uncommon to experience palpitations and associated breathing difficulties or panic attacks. It is not uncommon for sufferers to faint and possibly injure themselves in the event of a fall. The quality of life is considerably reduced by the bone marrow insufficiency. In most cases, it is also no longer possible to perform various sports or activities. There is also bleeding on the skin, which occurs sporadically and can thus make the patient’s everyday life more difficult. In the treatment of bone marrow insufficiency, there are usually no particular complications or complaints. However, the causative underlying disease cannot be cured in every case, so in some cases only the symptoms can be treated. Not infrequently, psychological treatment must also take place if depression or other psychological complaints occur. Whether there will be a reduction in life expectancy cannot be generally predicted.
When should you see a doctor?
If anemia is suspected to be present, a doctor should be consulted. If there is a pale complexion, increased formation of bruises, cold fingers or feet, and an increased need for sleep, there is cause for concern. Fatigue, rapid fatigability and a loss of the usual level of performance should be investigated and treated. A visit to the doctor is necessary as soon as the complaints persist over several weeks or increase in intensity. If other symptoms develop, a doctor should also be consulted. Sensitivity to cold, numbness of the skin or other sensitivity and sensory disturbances are indications that should be investigated. Detailed medical examinations will determine the cause so that appropriate treatment can be initiated. If the affected person suffers from palpitations, abnormalities of the heart rhythm, dizziness or internal weakness, he or she requires medical care. In severe cases, there is a risk of circulatory collapse, resulting in a life-threatening condition. If there are disturbances of consciousness as well as a loss of consciousness, action is required as soon as possible. A physician must be consulted or an ambulance service must be alerted. Problems with breathing, shortness of breath or interruptions in breathing indicate health disorders, and there is also an undersupply of the organism. A visit to the doctor is necessary to prevent the occurrence of acute conditions in time.
Treatment and therapy
In the treatment of bone marrow insufficiency, measures to control symptoms must be distinguished from interventions to control corresponding causes of the disease. For example, symptomatic therapy of bone marrow insufficiency aims to promote hematopoiesis in the affected individual. Depending on the patient and the form of bone marrow insufficiency, blood formation can be stimulated by the use of so-called anabolic steroids; these are usually artificially produced preparations based on testosterone (a male sex hormone). Growth factors, which can be produced using genetic engineering techniques, can also stimulate blood formation in cases of bone marrow insufficiency. If bone marrow insufficiency is due to severe anemia or if the affected patient has a strong tendency to bleed, the above-mentioned measures may not be medically appropriate; an alternative in this case is, for example, the transfer of blood products from donor blood. A medical measure to combat the cause is, for example, bone marrow transplantation; if intact bone marrow cells from a suitable donor can be successfully transferred to the patient, this can bring about a cure in some forms of bone marrow insufficiency.Other forms of cause control for bone marrow loss are directed at the particular factors that have led or are leading to the reduction of hematopoietic bone marrow cells in the individual.
Outlook and prognosis
Thanks to current medical options, the prognosis for bone marrow insufficiency is favorable in most patients. Doctors and physicians have various options for therapy that lead to significant relief of symptoms. Nevertheless, the final prognosis depends on the cause of the disease. In a large number of cases, long-term therapy is necessary. Despite all efforts, a complete cure of the patient is not always achieved. Nevertheless, various complaints can be successfully treated. Without medical care, the prognosis for the affected person is unfavorable. Various complications may occur, leading to premature death in severe cases. In making an overall prognosis, secondary diseases must be factored in. Emotional problems may occur, which are often protracted and affect the patient’s well-being and quality of life. Since the treatment as well as the individual complaints demand a lot from the patient, the probability of the occurrence of a mental illness is increased in addition to the physical complaints. If the only possible therapy is a bone marrow transplant, the corresponding risks and side effects must also be taken into account. A donor is needed so that a relief of the existing symptoms can be achieved. Otherwise, the prognosis deteriorates considerably.
Prevention
An already congenital form of bone marrow insufficiency usually cannot be prevented. Regular, medical checkups can help to diagnose diseases that may promote bone marrow insufficiency at an early stage. Appropriate, early treatment of possible underlying diseases can thus reduce the risk of bone marrow insufficiency occurring or worsening.
Follow-up
In bone marrow insufficiency, no special measures of aftercare are available to affected individuals. As a rule, a physician must be contacted at a very early stage in this disease to prevent further complications and also to prevent further worsening of the symptoms. However, in some cases the measures of aftercare are even completely limited, so that the focus is on early detection of the disease. In most cases, patients with this disease are dependent on taking various medications. It is always necessary to pay attention to the correct dosage with the regular intake. In case of any ambiguity or side effects, a doctor should be contacted immediately. Regular check-ups and examinations by a doctor are very important to detect further damage to the internal organs and to treat it at an early stage. Bone marrow insufficiency patients are often also dependent on the help and support of their own family in their daily lives. Possibly, the disease leads to a reduced life expectancy of the affected person. The further course is very much dependent on the time of diagnosis of the disease, so that no general course can be given in this case.
What you can do yourself
Patients with bone marrow insufficiency suffer both physically and psychologically from the symptoms typical of the disease and often wish for ways to improve their everyday quality of life on their own responsibility. However, medical therapy is the first priority, since the disease is sometimes accompanied by serious complications. Therefore, all self-help measures should be discussed with the specialist as a matter of principle. During bone marrow insufficiency, patients suffer from weakness, easy fatigability and a general decline in resilience. As a result, patients experience difficulties in performing their gainful employment as well as everyday activities. Patients should, however, allow themselves the necessary rest and under no circumstances overload themselves. This is because sudden loss of consciousness due to weakness increases the risk of accidents. Patients temporarily adjust their daily routine to the medical treatment and attend the necessary doctor’s and treatment appointments.Due to the reduced performance capacity, patients refrain from sports and strenuous activities. A close person supports the patients in their daily lives so that they do not overburden themselves. If sufferers develop depressive moods as a result of the symptoms and the associated psychological stress, they immediately seek the help of a psychotherapist to help them cope with the disease.
