Pancytopenia

Template:Pancytopenia 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 pronounced reduction in the number of erythrocytes, all types of white blood cells and blood platelets that are circulating in the blood.

Pancytopenia is generally due to diseases affecting the bone marrow, although peripheral destruction of all lines of blood cells in hypersplenism (overactive spleen) is a recognized cause. Bone marrow problems causing pancytopenia include myelofibrosis, leukemia, aplastic anemia, and the malignant form of osteoporosis.

Chemotherapy for malignancies may also cause pancytopenia, if the drug or drugs used cause bone marrow suppression.

Increasingly, HIV (Human Immunodeficiency Virus) is itself a cause for pancytopenia. Rarely, drugs (antibiotics, anti hypertensive medication, heart medication) can cause pancytopenia.

Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes.

Common Causes of Pancytopenia

1. Aplastic anemia
2. Myelodysplastic syndrome
3. Leukemia
4. Leishmaniasis
5. Severe Folate or Vitamin B12 deficiency
6. Paroxysmal nocturnal hemoglobinuria (Urine test)
7. Finally overwhelming viral infections (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 in Alphabetical Order

Aclarubicin Acute lymphoblastic leukemia Aggressive NK-cell leukemia Albendazole Alemtuzumab Alkylating antineoplastic agent Alkylators Amegakaryocytic thrombocytopenia Ankylosing spondylitis Anorexia nervosa Aplastic anemia Arsenicals Ataxia telangiectasia Auranofin Autoimmune lymphoproliferative syndrome type 1 Autoimmune lymphoproliferative syndrome type 2 Azathioprine Benzene Solvents Beta-emitters (eg, radioactive P-32) Bleeding (Excessive) Bloom's syndrome Brucellosis Busulphan Cancer treatment carbamazepine Carboplatin Castleman disease Chediak-Higashi disease Chloramphenicol Chondrosarcoma Chronic lymphocytic leukaemia Chronic myeloid leukaemia Clomipramine Colchicine toxicity Common variable hypogammaglobulinaemia Congenital neutropenia (Kostmann's or Shwachman-Diamond syndrome) Copper deficiency Cyclical neutropenia Cytotoxic drugs and radiation Defect in synthesis of adenosylcobalamin Dengue Diamond-Blackfan anemia DNA repair deficiencies Down syndrome (trisomy 21) Doxorubicin Dyskeratosis congenita Shwachman-Diamond syndrome

Environmental/occupational (eg, benzene) Eosinophilic fasciitis Epstein-Barr virus Seronegative Ewing sarcoma Familial histiocytic reticulosis Familial monosomy 7 Familial myelofibrosis Fanconi anaemia Flucytosine Folate deficiency Genotoxic therapy Germ cell tumors (embryonal dysgenesis) Glue vapors Glutathione synthase deficiency Gold Graft versus host disease Haemoglobin E disease Haemoglobin SC disease Hairy cell leukaemia Hematopoietic cell transplantation Hemoglobin H disease Hepatitis Hepatosplenic T-cell lymphoma Histiocytosis X Hodgkin lymphoma Human immunodeficiency virus (HIV) Hypersplenism Hypoplastic myelodysplastic syndromes Idarubicin Idiopathic indomethacin Ineffective erythropoiesis Intestinal lymphangiectasia Intrinsic factor deficiency (congenital) Iron deficiency Kwashiorkor Langerhans cell histiocytosis Large granular lymphocytic leukemia Lassa fever Legionella pneumophila Leucoerythroblastic anaemia Malabsorption syndrome Malignant histiocytosis Marasmus Megaloblastic anaemia Melanoma Metastatic neoplasm

Mutagen exposure Mutagen-detoxification (GSTq1-null) Mycobacterium tuberculosis Myelodysplastic syndrome Myelofibrosis Myeloma Myelpathic anemia Neurofibromatosis 1 Niemann-Pick disease Non steroidal anti-inflammatory drugs (NSAIDs): Non-Hodgkin lymphoma Obesity Oklahoma tick fever Osteoclastoma Osteopetrosis lethal Osteopetrosis, autosomal recessive 2 Osteosarcoma Paroxysmal nocturnal haemoglobinuria Parvovirus B19 infection phenacemide phenylbutazone, Plummer-Vinson syndrome Portal hypertension Pregnancy Prostate cancer propylthiouracil Q fever Renal failure, chronic Reticular dysgenesis Rheumatoid disease Severe combined immunodeficiency, T- B+ due to JAK3 deficiency Sickle cell disease sulfonamides, Systemic lupus erythematosus Thymoma Thyroid carcinoma Tobacco use Topoisomerase II interactive agents Trisomy 8 mosaicism Vitamin B12 deficiency Vitamin C deficiency Wiskott-Aldrich syndrome Xeroderma pigmentosum

• Environmental/occupational (eg, benzene)
• Eosinophilic fasciitis
• Epstein-Barr virus Seronegative
• Ewing sarcoma
• Familial histiocytic reticulosis
• Familial monosomy 7
• Familial myelofibrosis
• Fanconi anaemia
• Flucytosine
• Folate deficiency
• Genotoxic therapy
• Germ cell tumors (embryonal dysgenesis)
• Glue vapors
• Glutathione synthase deficiency
• Gold
• Graft versus host disease
• Haemoglobin E disease
• Haemoglobin SC disease
• Hairy cell leukaemia
• Hematopoietic cell transplantation
• Hemoglobin H disease
• Hepatitis
• Hepatosplenic T-cell lymphoma
• Histiocytosis X
• Hodgkin lymphoma
• Human immunodeficiency virus (HIV)
• Hypersplenism
• Hypoplastic myelodysplastic syndromes
• Idarubicin
• Idiopathic
• indomethacin
• Ineffective erythropoiesis
• Intestinal lymphangiectasia
• Intrinsic factor deficiency (congenital)
• Iron deficiency
• Kwashiorkor
• Langerhans cell histiocytosis
• Large granular lymphocytic leukemia
• Lassa fever
• Legionella pneumophila
• Leucoerythroblastic anaemia
• Malabsorption syndrome

|

• Malignant histiocytosis
• Marasmus
• Megaloblastic anaemia
• Melanoma
• Metastatic neoplasm
• Mutagen exposure
• Mutagen-detoxification (GSTq1-null)
• Mycobacterium tuberculosis
• Myelodysplastic syndrome
• Myelofibrosis
• Myeloma
• Myelpathic anemia
• Neurofibromatosis 1
• Niemann-Pick disease
• Non steroidal anti-inflammatory drugs (NSAIDs):
• Non-Hodgkin lymphoma
• Obesity
• Oklahoma tick fever
• Osteoclastoma
• Osteopetrosis lethal
• Osteopetrosis, autosomal recessive 2
• Osteosarcoma
• Paroxysmal nocturnal haemoglobinuria
• Parvovirus B19 infection
• phenacemide
• phenylbutazone,
• Plummer-Vinson syndrome
• Portal hypertension
• Pregnancy
• Prostate cancer
• propylthiouracil
• Q fever
• Renal failure, chronic
• Reticular dysgenesis
• Rheumatoid disease
• Severe combined immunodeficiency, T- B+ due to JAK3 deficiency
• Sickle cell disease
• sulfonamides,
• Systemic lupus erythematosus
• Thymoma
• Thyroid carcinoma
• Tobacco use
• Topoisomerase II interactive agents
• Trisomy 8 mosaicism
• Vitamin B12 deficiency
• Vitamin C deficiency
• Wiskott-Aldrich syndrome
• Xeroderma pigmentosum

|}

References

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