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When a patient presents with pancytopenia and hypocellular bone marrow, we suspect aplastic anemia (AA); the usual causes are drugs, chemicals, radiation, infections (e.g., hepatitis), tumors (e.g., thymoma), or paroxysmal nocturnal hemoglobinuria (PNH). AA sometimes appears initially during late adolescence or early adulthood in people with inherited disorders, such as Fanconi syndrome or dyskeratosis congenita. When all these conditions have been ruled out, the diagnosis is idiopathic AA, which generally is caused by an autoimmune attack on marrow stem cells. Treatment to suppress autoimmunity often is followed by improvement in blood counts. A combination of antithymocyte globulin (ATG) and cyclosporin (CyA) currently is recommended, but…