Pancytopenia

Pancytopenia is not equivalent with bone marrow suppression. Pancytopenia is a lab finding that may related to either bone marrow suppression or peripheral sequestration/destruction. For details about bone marrow suppression click here.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pancytopenia is the reduction in numbers of all three bone marrow cell types (RBCs + WBCs + platelets). It is not a disease, but rather a lab finding that may related to 1) bone marrow suppression caused by either insufficient production (aplastic anemia), inability of cells or mature (myelodysplasia), or replacement of normal bone marrow with fibrosis (myelofibrosis) or 2) peripheral sequestration/destruction that is not related to the bone marrow (e.g. splenomegaly or hypersplenism). HIV (Human Immunodeficiency Virus) is itself a cause for pancytopenia. Chemotherapy is associated with pancytopenia. Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes.

Causes

Common Causes

• Aplastic anemia
• Myelodysplastic syndrome
• Leukemia
• Leishmaniasis
• Folate deficiency
• Vitamin B12 deficiency
• Paroxysmal nocturnal hemoglobinuria
• Viral infections e.g. (HIV most common)

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes by Pathophysiology

Bone Marrow Failure

• Insufficient production (aplastic anemia)
• Inability of cells or mature (myelodysplasia)
• Replacement of normal bone marrow with fibrosis (myelofibrosis)

Peripheral Sequestration/Destruction

• Splenomegaly
• Hypersplenism

Congenital

• Cartilage hair hypoplasia
• Diamond-Blackfan syndrome
• Dubowitz syndrome
• Dyskeratosis congenita
• Familial aplastic anemia
• Fanconi's anemia
• Pearson syndrome
• Schwachman-Diamond syndrome
• TAR syndrome

Acquired

• Albers-Schonberg disease
• Banti's Syndrome
• Bone marrow tumor
• Cirrhosis
• Drugs/Toxins
• Felty's Syndrome
• Gaucher's Disease
• Graft-versus-host disease
• Infections
• Kala-Azar
• Leukemia
• Lymphoma
• Lymphoproliferative Disorders
• Myelodysplastic syndrome
• Myelofibrosis
• Niemann-Pick Disease
• Osteoporosis
• Pernicious anemia
• Reticulosis
• Sarcoidosis
• Thymoma
• Tuberculosis

References

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