Pancytopenia associations include which of the following drugs?

• A. Clozapine alone
• B. Asenapine, clozapine, olanzapine, quetiapine, risperidone, ziprasidone
• C. Olanzapine and Quetiapine
• D. Risperidone and Ziprasidone

Answer: (B)

Pancytopenia means suppression of the bone marrow affecting red cells, white cells, and platelets. While clozapine is the antipsychotic most famously linked to severe hematologic toxicity, several other atypical antipsychotics have been reported to be associated with pancytopenia in rare cases. The drugs listed—asenapine, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone—have all appeared in case reports or small series describing this outcome, reflecting a broader, though uncommon, risk across multiple agents. Because the associations span more than one drug, the option that includes this full set best represents the known, albeit rare, connections. In practice, if a patient on these medications develops signs of cytopenia (fatigue, fever, infections, easy bruising), discontinue the offending agent and evaluate with a complete blood count and further workup as indicated.