From the Guidelines
Pancytopenia is caused by a wide range of conditions that affect bone marrow function or increase peripheral cell destruction, including bone marrow failure syndromes, infections, medications, autoimmune disorders, nutritional deficiencies, and inherited disorders. The most common causes of pancytopenia include:
- Bone marrow failure syndromes like aplastic anemia, myelodysplastic syndromes, and leukemias that infiltrate and replace normal bone marrow elements 1
- Infections such as HIV, tuberculosis, and viral hepatitis that can suppress bone marrow production 1
- Certain medications including chemotherapy drugs, antibiotics (chloramphenicol, trimethoprim-sulfamethoxazole), and anticonvulsants (phenytoin, carbamazepine) that can cause bone marrow suppression 1
- Autoimmune disorders like systemic lupus erythematosus and rheumatoid arthritis that may trigger immune-mediated destruction of blood cells 1
- Nutritional deficiencies, particularly vitamin B12, folate, and copper, that are important reversible causes 1
- Hypersplenism from portal hypertension or other splenic disorders that can cause pancytopenia through increased sequestration and destruction of blood cells 1
- Inherited bone marrow failure syndromes like Fanconi anemia and dyskeratosis congenita that typically present in childhood but can manifest later 1
- Paroxysmal nocturnal hemoglobinuria, radiation exposure, and toxin exposure (benzene, alcohol) that are additional causes 1 Identifying the specific cause of pancytopenia requires a thorough evaluation including complete blood count with peripheral smear, bone marrow examination, and targeted testing based on clinical suspicion 1.
From the Research
Causes of Pancytopenia
Pancytopenia is a condition characterized by a reduction in the number of red blood cells, white blood cells, and platelets in the blood. The causes of pancytopenia can be varied and include:
- Idiopathic aplastic anemia 2
- Inherited bone marrow failure syndromes 2
- Drugs 2
- Infections 2
- Nutritional deficiencies 2
- Rheumatologic disease 2
- Megaloblastic anaemia 3, 4
- Aplastic anaemia 3, 4
- Hypersplenism 3, 4
- Leukaemia 3, 4
- Myelodysplastic syndrome 5, 6
- Myelofibrosis 6
- Kala-azar 6
- Alcoholic liver disease 3
- Haemolytic anaemia 3
- HIV 3
- Dengue 3
- Systemic lupus erythematosus 3
- Viral hepatitis 3
- Disseminated TB 3
- Multiple myeloma 3
Bone Marrow Failure Syndromes
Bone marrow failure syndromes, such as aplastic anemia, can cause pancytopenia by reducing the production of blood cells in the bone marrow 2, 5. These syndromes can be treated with immunosuppressive therapy, bone marrow transplantation, or other supportive care measures 2, 5.
Other Causes
Other causes of pancytopenia include sepsis, nutritional deficiencies, and rheumatologic diseases 2, 3. A comprehensive clinical and haematological study of patients with pancytopenia is necessary to identify the underlying cause of the condition 3.
Hemorrhagic Manifestations
Hemorrhagic manifestations can occur in patients with pancytopenia, particularly those with aplastic anemia, leukemia, myelodysplastic syndrome, and myelofibrosis 6. These manifestations can be life-threatening and require prompt medical attention.