Pancytopenia is a reduction in the number of red blood cells, white blood cells, and platelets in the peripheral blood below the lower limits of the age-adjusted normal range for healthy people. It is therefore the combination of anemia, leukopenia, and thrombocytopenia.
Pancytopenia may result from decreased production of blood cells, resulting from bone marrow failure, or immune-mediated destruction of blood cells, or non-immune-mediated sequestration in the periphery/spleen.
The diagnosis of pancytopenia is made from the results of an automated complete blood count and examination of the peripheral smear but, as the etiology of pancytopenia varies significantly, a detailed diagnostic evaluation is required in every instance.
- Radiation therapy
- Vitamin B12 deficiency
- Folic acid deficiency
- Bone marrow infiltration by nonhematologic malignancy
- Non-Hodgkin lymphoma
- Hairy cell leukemia
- Chronic lymphocytic leukemia
- Seronegative (idiopathic) hepatitis (likely autoimmune)
- Hepatitis B
- Hepatitis C
- Autoimmune hepatitis
- Cytomegalovirus infection
- Mycobacterial infection
- Acute myeloid leukemia
- Acute lymphocytic leukemia (ALL)
- Multiple myeloma
- Lysosomal storage disorders
- Anorexia nervosa
- Graft-versus-host disease (GVHD)
- Heavy metal (arsenic) poisoning
- Parvovirus infection in sickle cell anemia (and other hemolytic anemias)
- Dyskeratosis congenita (DC)
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Idiopathic aplastic anemia
- Fanconi anemia
- Other rare inherited cytopenias (e.g., Diamond-Blackfan anemia, Shwachman-Diamond syndrome, amegakaryocytic thrombocytopenia)
- Idiopathic portal hypertension
- Chronic myeloid leukemia
- Hemophagocytosis syndromes
- Drug-induced immune pancytopenia
- Evans syndrome with associated neutropenia
- Autoimmune lymphoproliferative syndrome (ALPS)
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Infectious mononucleosis
- Felty syndrome
Jeffrey M. Lipton, MD, PhD
Frances and Thomas Gambino Professor of Pediatrics in Hematology/Oncology
Professor of Pediatrics and Molecular Medicine
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Professor, The Center for Autoimmune Musculoskeletal and Hematopoietic Diseases
Feinstein Institute for Medical Research
Director, Hematology/Oncology and Stem Cell Transplantation
Cohen Children's Medical Center of New York
JML declares that he has no competing interests.
Dr Jeffrey M. Lipton would like to gratefully acknowledge Dr Jeff K. Davies and Dr Eva C. Guinan, the previous contributors to this topic.
JKD and ECG declare that they have no competing interests.
Stella Davies, MD, PhD
Professor and Division Director
Cincinnati Children's Hospital Medical Center
SD declares that she has no competing interests.
Drew Provan, BSc, MBChB
Department of Hematology
The Royal London Hospital
DP was medical director at GlaxoSmithKline 2005-2006.
Alfred P. Gillio, MD
Bone Marrow Failure Clinic
Tomorrows Children's Institute
Hackensack University Medical Center
APG declares that he has no competing interests.
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