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Impaired production [1][2][3] Nutritional deficiencies, e.g.: Vitamin B12 deficiency Folate deficiency Copper deficiency Aplastic anemia etiologies Acquired, e.g.: Idiopathic Radiation injury Alcohol use disorder Medications, Viral, bacterial, or parasitic infections Sepsis Inherited bone marrow failure disorders, e.g., Fanconi anemia Malignant bone marrow infiltration Acute leukemia, e.g.: Acute myeloid leukemia (AML) Acute promyelocytic leukemia (APL) Acute lymphoblastic leukemia (ALL) Other myeloid neoplasms, e.g.: Myelodysplastic syndromes (MDS) Myelofibrosis Chronic myeloid leukemia (CML) Multiple myeloma Lymphoproliferative disorders, e.g.: Low-grade non-Hodgkin lymphomas with marrow involvement Hodgkin lymphoma Hairy cell leukemia Marrow infiltration by solid organ malignancy, e.g.: Lung cancer, Breast cancer Prostate cancer Nonmalignant bone marrow infiltration, e.g.: Gaucher disease TB Leishmaniasis Increased destruction or loss [1][2] Autoimmune, e.g.: autoimmune hemolytic pancytopenia Thrombotic microangiopathies, e.g.: disseminated intravascular coagulation (DIC) Splenic sequestration, e.g.: due to portal hypertension Impaired production and increased destruction [2] Medications, e.g.: [3] Antibiotics, e.g., chloramphenicol, trimethoprim Antiepileptic drugs, e.g., carbamazepine, valproate Chemotherapeutic agents Immunosuppressants, e.g., azathioprine, methotrexate Infections, e.g.: Malaria Schistosomiasis Viral infections Autoimmune conditions: e.g., systemic lupus erythematosus (SLE), rheumatoid arthritis Other, e.g.: Hemophagocytic lymphohistiocytosis (HLH), e.g., due to viral infection Paroxysmal nocturnal hemoglobinuria (PNH) Transfusion-associated graft-versus-host
Pancytopenia Causes — Memory System 🧠
The Big Picture: 3 Mechanisms
"PID" — Production ↓ | Increased Destruction | Dual (both)
🔴 MECHANISM 1: Impaired Production
Sub-group A: Nutritional ("VFC")
| Letter | Deficiency |
|---|---|
| V | Vitamin B12 |
| F | Folate |
| C | Copper |
Sub-group B: Aplastic Anemia — "IRAMA-V"
"I RAM A Virus"
| Letter | Cause |
|---|---|
| I | Idiopathic |
| R | Radiation injury |
| A | Alcohol use disorder |
| M | Medications |
| A | Acquired infections (viral/bacterial/parasitic) + Sepsis |
| V | Via inheritance → Fanconi anemia |
Sub-group C: Malignant Marrow Infiltration — "ALL AML APL — MDS MF CML MM — NHL HL HCL — LBP"
Row 1 — Acute Leukemias: "AAA"
- AML, APL, ALL
Row 2 — Other Myeloid: "MMCM" (My Myeloid Cells Matter)
- MDS, Myelofibrosis, CML, Multiple myeloma
Row 3 — Lymphoproliferative: "NHL + HH"
- Non-Hodgkin Lymphoma (low-grade), Hodgkin, Hairy cell leukemia
Row 4 — Solid Tumors invading marrow: "LBP" (Lung Breast Prostate)
- Lung, Breast, Prostate
Sub-group D: Non-malignant Marrow Infiltration — "GTL" (Got The Lesion)
| Letter | Disease |
|---|---|
| G | Gaucher disease |
| T | TB |
| L | Leishmaniasis |
🟡 MECHANISM 2: Increased Destruction/Loss
Mnemonic: "ATS" (A Tiger Spills)
| Letter | Cause |
|---|---|
| A | Autoimmune hemolytic pancytopenia |
| T | Thrombotic microangiopathy (DIC) |
| S | Splenic sequestration (portal hypertension) |
🟠 MECHANISM 3: Both (Impaired + Destroyed)
Mnemonic: "MACIAS + HPT"
"My MACIAS Has Problems Too"
| Letter | Cause |
|---|---|
| M | Medications (chloramphenicol, carbamazepine, valproate, azathioprine, MTX, chemo) |
| A | Autoimmune (SLE, RA) |
| I | Infections (malaria, schistosomiasis, viral) |
| H | HLH (Hemophagocytic lymphohistiocytosis) |
| P | PNH (Paroxysmal nocturnal hemoglobinuria) |
| T | Transfusion-associated GvHD |
🗺️ One-Page Master Summary
PANCYTOPENIA
│
├── 1. IMPAIRED PRODUCTION
│ ├── Nutritional: VFC (B12, Folate, Copper)
│ ├── Aplastic: IRAMA-V
│ ├── Malignant infiltration:
│ │ AAA → MMCM → NHL+HH → LBP
│ └── Non-malignant infiltration: GTL
│
├── 2. INCREASED DESTRUCTION
│ └── ATS (Autoimmune, TMA/DIC, Splenic)
│
└── 3. BOTH
└── MACIAS + HPT
Quick Drug Sub-mnemonic for Meds (Mechanism 3):
"Can Trim Cars, Value Aza-MTX, Chemo"
- Chloramphenicol, Trimethoprim → Antibiotics
- Carbamazepine, Valproate → Antiepileptics
- Azathioprine, MTX → Immunosuppressants
- Chemotherapeutic agents