Bicytopenia Causes and Considerations

Non-Malignant Hematologic Disorders

Myelodysplastic syndromes (MDS) characteristically present with refractory cytopenias affecting one or two lineages before progressing to pancytopenia, as classified by the WHO, according to the National Comprehensive Cancer Network 2, 3
The American College of Hematology recommends considering MDS in patients with bicytopenia, given its potential to progress to pancytopenia, as noted in the Annals of Oncology 2

HIV infection causes bicytopenia through multiple mechanisms including direct marrow suppression, immune-mediated destruction, and opportunistic infections, as reported in the Journal of Allergy and Clinical Immunology 4
The Infectious Diseases Society of America notes that HIV infection is a common cause of bicytopenia, particularly in immunocompromised patients, according to the Journal of Allergy and Clinical Immunology 4

Lymphoma produces bicytopenia through marrow infiltration, hypersplenism, or autoimmune mechanisms, as reported in the Journal of Allergy and Clinical Immunology 4
The National Comprehensive Cancer Network recommends considering lymphoma in patients with bicytopenia, given its potential to cause marrow infiltration and hypersplenism, according to the Journal of Allergy and Clinical Immunology 4

Chemotherapy agents commonly cause bone marrow suppression leading to bicytopenia or pancytopenia through direct cytotoxic effects, as reported in the Journal of the National Comprehensive Cancer Network 7
The American Society of Clinical Oncology notes that chemotherapy agents are a common cause of bicytopenia, particularly in patients receiving CAR T-cell therapy, according to the Journal of the National Comprehensive Cancer Network 7

Antiphospholipid syndrome causes thrombocytopenia with associated anemia through thrombotic microangiopathy mechanisms, as reported in Praxis Medical Insights 1
The American College of Rheumatology recommends considering antiphospholipid syndrome in patients with bicytopenia, given its potential to cause thrombotic microangiopathy, according to Praxis Medical Insights 1

Elderly patients (>60 years) with bicytopenia require bone marrow examination to exclude myelodysplastic syndromes, leukemias, or other malignancies, as recommended by Praxis Medical Insights 1, 6
The American Geriatrics Society notes that elderly patients with bicytopenia are at increased risk of underlying malignancies, and recommends bone marrow examination to exclude these conditions, according to Praxis Medical Insights 1, 6

CAR T-cell therapy produces prolonged cytopenias including bicytopenia in weeks to months after infusion, with factors including CRS severity, disease burden, and prior therapies contributing, as reported in the Journal of the National Comprehensive Cancer Network 7
The American Society of Clinical Oncology recommends monitoring patients receiving CAR T-cell therapy for bicytopenia, given its potential to cause prolonged cytopenias, according to the Journal of the National Comprehensive Cancer Network 7