Which drug is classically associated with aplastic anemia?

• A. Antimetabolite cancer drugs
• B. Phenylbutazone (Butazolidin)
• C. Oral contraception drugs
• D. Chloramphenicol (Chloromycetin)

Answer: (D)

Aplastic anemia is when the bone marrow fails to produce enough red cells, white cells, and platelets, leading to fatigue, infection risk, and bleeding tendency. Certain drugs can trigger this severe, potentially life‑threatening marrow failure. The drug most classically linked to aplastic anemia is chloramphenicol. This antibiotic can cause a serious, idiosyncratic reaction that is not strictly dose-related, resulting in pancytopenia and a hypocellular marrow. Because of this risk, chloramphenicol is used with great caution and often avoided when safer alternatives exist. When exposure has occurred, stopping the drug is essential, and management focuses on supportive care—preventing infection, providing transfusions if needed, and consulting hematology for severe cases, where bone marrow transplantation may be considered. While other drugs, including some antineoplastic agents, can cause bone marrow suppression, chloramphenicol remains the classic association with aplastic anemia.