Bone Marrow Failure

Bone marrow failure occurs when the bone marrow does not make enough of one or more types of blood cells. This leads to low blood counts, which may cause anemia, infections or bleeding problems. It can result from inherited conditions, acquired diseases, medicines, toxins or medical treatments. Bone marrow failure can affect children or adults, depending on its cause.

Bone marrow is the soft tissue inside certain bones, including the hip bones, breastbone and vertebrae. Its main function is to produce red blood cells, white blood cells and platelets. Red blood cells carry oxygen, white blood cells help fight infection and platelets help control bleeding. The term “bone marrow failure” describes a disease process; it does not mean that healthy bone marrow is harmful or beneficial as a food.

Inherited and acquired causes

Inherited marrow-failure syndromes can interfere with blood-cell production because of changes in genes passed through families. Acquired causes include immune-mediated aplastic anemia, chemotherapy or radiation, certain medicines or toxic chemicals, viral infections and nutritional deficiencies such as a lack of vitamin B12 or folate. Blood cancers and other bone marrow disorders can also affect the marrow’s ability to make healthy cells. Although some cases have a clear trigger, the cause is not always identified.

Clinicians use these results to determine whether the marrow is producing too few cells or whether cells are being destroyed or lost elsewhere. Testing can also help identify a blood cancer, bone marrow cancer, inherited syndrome or another bone marrow disorder responsible for the abnormal counts.

Management may include monitoring blood counts, red-cell or platelet transfusions, infection prevention and prompt treatment of infections. Depending on the cause, treatment may involve stopping a causative medicine or exposure, immune-suppressing medicines, growth-factor medicines, targeted treatment for an underlying disorder or nutritional replacement when a deficiency is present. Hematopoietic stem cell transplantation may offer a potentially curative option for selected patients. Eligibility depends on age, overall health, cause, disease severity and donor availability.

Some acquired causes improve when the trigger is removed or treated. Inherited conditions and severe bone marrow failure may require long-term specialist care or transplantation. The expected course differs from person to person and depends on the underlying diagnosis and response to treatment.