Snapshot A 15-year-old girl presents to the emergency room with a nosebleed that has not stopped for hours. She also has bleeding in her gums. She was recently started on carbamazepine for a newly diagnosed epileptic condition. Lab results reveal decreased counts in all leukocyte counts. Reticulocyte count is decreased as well. Carbamazepine is discontinued and a bone marrow biopsy is obtained. Introduction Pancytopenia caused by diminished, absent, or destructed hematopoietic stem cells With bone marrow aplasia Epidemiology login to view 2 more bullets Multiple different causes login to view 23 more bullets Commonly seen in sickle cell patients who are infected with parvovirus B19 Presentation Symptoms/physical exam login to view 4 more bullets Evaluation Diagnosis of exclusion Labs login to view 4 more bullets Bone marrow biopsy login to view 1 more bullet Differential Diagnosis PNH Myelodysplastic syndrome Infection Treatment Withdrawal causative agent if applicable Supportive therapy login to view 2 more bullets Bone marrow transplant Antithymocyte globulin plus cyclosporine Hematopoietic growth factors (G-CSF and GM-CSF) Prognosis, Prevention, and Complications Prognosis login to view 3 more bullets Complications login to view 4 more bullets