Skip to Main Content





After studying this chapter you should be able to:

  • Establish a differential diagnosis of pancytopenia.

  • Classify the primary bone marrow disorders.

  • Explain the pathogenesis of aplastic anemia and the principles underlying its treatment.


It is clear from the information presented in Chapter 2 that the regulated production of circulating blood cells depends on the presence of an adequate number of functional multipotent hematopoietic stem cells. Accordingly, disease processes that either injure stem cells directly or compromise their environmental niche within the bone marrow result in a decrease in the numbers and sometimes the function of circulating blood cells. Thus, these bone marrow disorders often give rise to pancytopenia, a reduction in the numbers of circulating red cells, leukocytes, and platelets.


A variety of disorders can cause pancytopenia (Table 4-1). Because red cells, leukocytes, and platelets are all produced in the bone marrow, it is no surprise that microscopic examination of this organ by aspiration and biopsy is critical in evaluating patients with pancytopenia. As shown in the italicized portions of Table 4-1, this chapter will cover disorders involving injury to hematopoietic stem cells as well as those characterized by perturbation of the marrow microenvironment due to infiltration by cells that are extrinsic to the marrow (myelophthisis). Severe pancytopenia is a hallmark of marrow aplasia, whereas more variable degrees of cytopenia are encountered in myelophthisic disorders. Additional causes of pancytopenia listed in Table 4-1 are covered in other chapters of this book.

Table Graphic Jump Location
TABLE 4-1Causes of Pancytopenia





Because over 95% of the cells in the bone marrow are progeny of hematopoietic stem cells, injury to these cells will result in a marked decrease in cellularity. Figure 4-1 compares a low-magnification view of normal bone marrow with that of bone marrow from a patient with severe aplastic anemia. In this specimen (Fig. 4-1B) it would be difficult to identify any cells of the erythroid, myeloid, or megakaryocyte lineages. The few cells that can be identified are a mix of lymphocytes, plasma cells, and marrow stroma that includes endothelial cells and fibroblasts.


Bone marrow biopsies. A) ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.