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A 23-year-old man presents with recurrent nose-bleeds and infection after a course of chemotherapy.

D Aplastic anaemia is a presentation of pancytopenia with hypoplastic marrow. Aplastic anaemia can be either primary or secondary. The most common cause of primary aplastic anaemia is idiopathic acquired aplastic anaemia. Congenital causes of primary aplastic anaemia are very rare, e.g. Fanconi’s anaemia. Secondary causes of aplastic anaemia include infection (especially viral, e.g. hepatitis, measles, parvovirus B19) and drugs. Cytotoxic drugs such as busulphan and doxorubicin are wellrecognized causes of secondary aplastic anaemia via a type A (doserelated) response. Non-cytotoxic drugs such as chloramphenicol and gold have also been reported to cause aplasia via a type B (not dose-related) response. Rarely, pregnancy is associated with a secondary aplastic anaemia.