An Overview of Pancytopenia

Combination of Low Red Cells, White Blood Cells, and Platelets

lab technician looking at a blood sample with pancytopenia

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Pancytopenia is a descriptive term referring to the combination of low levels of all of the types of blood cells including red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia). Symptoms, which often occur due to the reduced levels of these cells, include fatigue, infections, and bruising.

There are a number of different conditions that can cause pancytopenia, including bone marrow diseases, some cancers, and some infections; chemotherapy treatment can also cause pancytopenia. The treatment options for pancytopenia depend on the specific causes and usually focus on increasing the levels of cells to improve symptoms while treating the underlying cause.

Blood Cells Affected by Pancytopenia

Pancytopenia refers to a deficiency in all of our three major types of blood cells. Specifically, these include:

  • Red blood cells (RBCs): RBCs are the cells which bind and carry oxygen to the tissues of the body.
  • White blood cells (WBCs): There are several types of WBCs which are further broken down into granulocytes (including neutrophils, eosinophils, and basophils), and agranulocytes (including lymphocytes and monocytes). These cells are responsible for fighting off infections among other functions.
  • Platelets: Platelets are responsible for blood clotting.

Describing Low Levels of Blood Cells

These terms are used for lower levels of blood cells:

  • A low level of red blood cells is referred to as anemia. It's important to note that there are different forms of anemia. One form is a low level of red blood cells, but it may also be due to blood loss, a low level of hemoglobin, a deficiency of vitamin B12, and other causes.
  • A low level of WBCs is referred to as leukopenia (you may hear of neutropenia, which refers to a low level of the particular type of WBCs known as neutrophils).
  • A low level of platelets is referred to as thrombocytopenia, such as immune thrombocytopenia, and chemotherapy-induced thrombocytopenia.

Formation of Blood Cells in the Bone Marrow or Hematopoiesis

Blood cells all originate from a single common cell in the bone marrow known as a hematopoietic stem cell (HSM) or pluripotential stem cells (meaning that it has the "potential" to become many different types of cells). These cells divide and through a process called hematopoiesis become progressively more specialized into all of the blood cells in the body.

Lab Tests

Pancytopenia is usually diagnosed by looking at a complete blood count (CBC).

In pancytopenia, a CBC will show deficient levels of all the types of blood cells including:

  • A red blood cell count of fewer than 4.2 million cells/cc in women or less than 4.7 million cells/cc in men (This may also be described by a low hemoglobin level).
  • A white blood count less than 4,000 cells/cc (normal is between 4,000 and 10,000 cells/cc).
  • A platelet count less than 150,000 cells/cc (normal is between 150,000 and 400,000 cells/cc).


Pancytopenia may be caused by anything which interferes with the formation of blood cells in the bone marrow or blood cell availability in the bloodstream (such as if they are held in the spleen).

This may involve bone marrow destruction by toxins, bone marrow suppression (during chemotherapy), or the replacement of bone marrow by other cells resulting in the disruption of blood cell production, as can occur with some cancers. Blood cell destruction or suppression may occur from inflammation, infections, or autoimmune conditions.

Most of these conditions are acquired later in life, but a few are inherited and present from birth.

Some of the possible causes of pancytopenia include:

  • Chemotherapy-induced bone marrow suppression
  • Drug-induced: drugs other than chemotherapy drugs, from antibiotics to heart-disease medications, have been cited as causes.
  • Infections, such as infectious mononucleosis and HIV, as well as overwhelming infections (sepsis).
  • Aplastic anemia.
  • Splenic sequestration (holding of blood cells in the spleen so they can't get to the rest of the body).
  • Toxins and chemical exposure, such as exposure to arsenic or benzene. 
  • Blood cancers in the bone marrow such as leukemia, lymphoma, myeloma, or metastatic cancer to bone marrow.
  • Spread of some solid tumors to the bone marrow, especially breast cancer, prostate cancer, colon cancer, gastric cancer, and melanoma. With bone marrow metastases, the most common symptom is anemia followed by thrombocytopenia.
  • Myelodysplastic syndromes ("pre-cancerous" conditions of the bone marrow)
  • Autoimmune disorders, such as lupus
  • Radiation sickness
  • Inherited syndromes, such as Fanconi anemia and Diamond Blackfan anemia

Most Common Causes

A 2014 study set out to determine the most common causes of pancytopenia in people who were not already diagnosed with a condition. For example, none of these adults had received chemotherapy or had obvious reasons for their pancytopenia.

Of these study participants:

  • Over 60% had some type of blood-related cancer. Most common were acute myelogenous leukemia and myelodysplasia.
  • Those not found to have blood-related cancer as the cause of their pancytopenia, had other conditions, including aplastic anemia, megaloblastic anemia, and human immunodeficiency virus (HIV)-related changes.


Pancytopenia symptoms may include weakness or an enlarged spleen in addition to symptoms related to deficiency of specific blood cells. Some of these symptoms include:

  • Symptoms related to anemia (a low red blood cell count) including pallor, fatigue, rapid heart rate, and shortness of breath.
  • Symptoms related to a leukopenia or neutropenia (a low white count) including fever and signs of infection such as a cough or pain with urination
  • Symptoms related to thrombocytopenia (low platelets) including easy bruising, and heavy bleeding

Diagnosis and Evaluation

Pancytopenia may be noted on a complete blood count (CBC). A first step in evaluating low levels of all cells is to repeat the CBC. A peripheral blood smear is then done to look further at each of the different types of cells. If it appears that you truly have pancytopenia, the first step is often a bone marrow biopsy.

A bone marrow aspiration and biopsy looks at the components of bone marrow, which include hematopoietic stem cells (the cells that differentiate into all of the different types of blood cells), blood cells in various phases of maturation, and supplies used to make blood cells, such as iron and vitamin B12. In addition to looking at B12 levels in the blood, special stains and tests are done on the cells to look for changes, such as chromosomal and gene changes, often found with leukemias.


The goal of treating pancytopenia is to find and treat the underlying cause. If the cause is not known, or if it is expected, such as with chemotherapy, treatment is aimed at minimizing the symptoms related to a deficiency of the blood cells. Some treatments that may be used include:

  • Drugs that stimulate the bone marrow. For chemotherapy-induced neutropenia and some other causes, the growth factors Leukine, Neupogen, or Neulasta may be used to stimulate the formation of WBCs. For chemotherapy-induced anemia, there are also some medications that may be considered.
  • Blood transfusions
  • Immunosuppressive drugs if cause is due to an autoimmune condition.
  • Bone marrow transplant or stem cell transplant.


The prognosis of pancytopenia depends largely upon its cause. Thankfully, we now have treatments such as transfusions and stimulating factors to help with the specific blood cell deficiency while the underlying condition is evaluated and treated.

A Word From Verywell

There are many potential causes of pancytopenia, but all carry risks. With pancytopenia, all types of blood cells are reduced, although reductions in some may be of more concern than others.

Example: Dan developed pancytopenia—a low level of red blood cells, white blood cells, and platelets—after his last chemotherapy treatment.

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