If only two parameters from the complete blood count are low, the term bicytopenia can be used. The diagnostic approach is the same as for pancytopenia.
Iatrogenic causes of pancytopenia include chemotherapy for malignancies if the drug or drugs used cause bone marrow suppression. Rarely, drugs (antibiotics, blood pressure medication, heart medication) can cause pancytopenia. For example, the antibiotic chloramphenicol can cause pancytopenia in some individuals.
- Familial hemophagocytic syndrome
- Aplastic anemia
- Gaucher's disease
- Metastatic carcinoma of bone
- Multiple Myeloma
- Overwhelming infections
- Dyskeratosis congenita
- Myelodysplastic syndrome
- Severe folate or vitamin B12 deficiency
- Systemic lupus erythematosus
- Paroxysmal nocturnal hemoglobinuria (blood test)
- Viral infections (such as HIV, EBV; an undetermined virus is most common)
- Alimentary toxic aleukia
- Copper deficiency
- Pernicious anemia
- Organic acidurias (Propionic Acidemia, Methylmalonic Aciduria, Isovaleric Aciduria)
- Low dose arsenic poisoning
- Sako disease (Myelodysplastic-cytosis)
- Chronic radiation sickness
- LIG4 syndrome
The mechanisms for pancytopenia differ according to the etiology. For example, in hemophagocytic lymphohistiocytosis (HLH) there is marked inappropriate and ineffective T cell activation that leads to an increased hemophagocytic activity. The T cell activated macrophages engulf erythrocytes, leukocytes, platelets, as well as their progenitor cells. Along with pancytopenia, HLH is characterized by fever, splenomegaly, and hemophagocytosis in bone marrow, liver, or lymph nodes.
Pancytopenia usually requires a bone marrow biopsy in order to distinguish among different causes.
- anemia: hemoglobin < 13.5 g/dL (male) or 12 g/dL (female).
- leukopenia: total white cell count < 4.0 x 109/L. Decrease in all types of white blood cells (revealed by doing a differential count).
- thrombocytopenia: platelet count < 150×109/L.
- Abdollahi, M.; Mostafalou, S. (2014), "Chloramphenicol", Encyclopedia of Toxicology, Elsevier, pp. 837–840, doi:10.1016/b978-0-12-386454-3.00709-0, ISBN 978-0-12-386455-0, retrieved 2020-12-11
- Kossenko MM, Akleyev AA, Degteva MO, Kozheurov VP, Degtyaryova RC (August 1994). "Analysis of Chronic Radiation Sickness Cases in the Population of the Southern Urals (AD-A286 238)". DTIC. p. 5. Retrieved 1 August 2013.
Complete blood counts, when taken, revealed pancytopenia.
- EID Journal (Volume 6, Number 6), CDC, December 2000.