Causes of pancytopenia (organized by mechanism^*)

Acquired

Bone marrow infiltration/replacement
- Malignant
  - Acute leukemias
  - Chronic leukemias/myeloproliferative neoplasms (MPN)
  - Myelodysplastic syndromes (MDS)
  - Multiple myeloma
  - Metastatic cancer
- Nonmalignant
  - Infectious (eg, fungal, tuberculous)
  - Storage diseases
Bone marrow failure
- Immune destruction/suppression
  - Aplastic anemia/paroxysmal nocturnal hemoglobinuria
  - Medications^¶
    - Cytotoxic drugs
    - Idiosyncratic reactions to medications
  - Large granular lymphocyte leukemia
  - Autoimmune disorders (eg, systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], sarcoidosis)
  - Hemophagocytic lymphohistiocytosis (HLH)
- Nutritional
  - Megaloblastic (vitamin B12, folate)
  - Excessive alcohol
  - Other (eg, copper deficiency, zinc toxicity)
  - Malnutrition/anorexia nervosa with gelatinous degeneration
- Marrow suppression
  - Viral infection (eg, HIV, hepatitis, Epstein-Barr virus [EBV])
- Ineffective hematopoiesis (eg, MDS, nutritional)
Destruction/sequestration/redistribution
- Consumption
  - Disseminated intravascular coagulation (eg, associated with sepsis, acute promyelocytic leukemia)
- Splenomegaly
  - Portal hypertension/cirrhosis
  - Infections (eg, EBV)
  - Autoimmune disorders (eg, SLE, RA/Felty syndrome)
  - Malignancies (eg, lymphomas, MPN)
  - Myelofibrosis with myeloid metaplasia
  - Storage diseases (eg, Gaucher)

Congenital

Wiskott Aldrich syndrome
Fanconi anemia
Dyskeratosis congenital/telomere biology disorders
Shwachman-Diamond syndrome
GATA2 deficiency
HLH

* Note that some disorders are included in more than one category, as they may cause cytopenias by multiple mechanisms (eg, lymphomas may be associated with bone marrow failure due to marrow replacement, increased sequestration due to splenomegaly, and immune destruction).

¶ Refer to accompanying table of drugs associated with cytopenias.

Graphic 112134 Version 5.0

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Causes of pancytopenia (organized by mechanism*)

Causes of pancytopenia (organized by mechanism^*)