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Causes of Acute Bone Marrow Failure

Potential causes of acute bone marrow failure include acute leukemia, megaloblastic anemia, and toxic effects of heavy metals or radiation. In this Clinical Problem-Solving article, the patient’s acute bone marrow failure was caused by a medication error that led to methotrexate toxicity. However, even low-dose methotrexate can cause myelosuppression, especially in the presence of predisposing factors such as reduced renal function, hypoalbuminemia, and folate deficiency. Polymorphisms in the methylenetetrahydrofolate reductase gene may also be a predisposing factor. Additionally, interactions between methotrexate and certain other drugs (such as trimethoprim-sulfamethoxazole) can result in myelosuppression.