Pancytopenia is a decrease in all 3 peripheral blood lineages presenting as simultaneous anemia, leukopenia, and thrombocytopenia.
Acquired pancytopenia has many etiologies, but it is broadly grouped into 1 of 3 mechanisms causing decreased blood cell counts: bone marrow infiltration / replacement, bone marrow aplasia, or blood cell destruction or sequestration. Multiple mechanisms may occur simultaneously.
Bone marrow infiltration / replacement may be secondary to hematologic malignancy (such as lymphoma, myeloma, leukemia, myelodysplastic syndrome), myelofibrosis, metastatic disease, and infectious processes (tuberculous, fungal infection, etc). Bone marrow aplasia may be due to nutritional deficiencies, viral infection, immune destruction, drug effect, toxic exposures, or aplastic anemia. Blood cell destruction may occur due to ineffective hematopoiesis (ie, myelodysplastic syndrome), disseminated intravascular coagulation, or thrombotic thrombocytopenic purpura. Hypersplenism causes sequestration and is associated with various disease states (cirrhosis, lymphoma, autoimmune disorders, etc).
Acquired pancytopenia in Adult
Alerts and Notices
Synopsis

Codes
ICD10CM:
D61.818 – Other pancytopenia
SNOMEDCT:
5876000 – Acquired pancytopenia
D61.818 – Other pancytopenia
SNOMEDCT:
5876000 – Acquired pancytopenia
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Acute leukemia (eg, acute lymphoid leukemia, acute promyelocytic leukemia, acute myelogenous leukemia)
- Lymphoma infiltrating the bone marrow
- Hemophagocytic lymphohistiocytosis
- Myelofibrosis
- Myelodysplastic syndrome
- Human immunodeficiency virus (HIV) disease or other viral disease
- Metastatic disease to the bone marrow
- Drug-induced pancytopenia
- Toxin exposure
- Chemotherapy effects
- Aplastic anemia
- Heritable causes such as Fanconi anemia
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:08/13/2019
Last Updated:08/13/2019
Last Updated:08/13/2019