A 42-year-old male developed thrombocytopenia and anemia along with agranulocytosis during treatment with procainamide. Bone marrow hypoplasia was evident on biopsy, and the patient was without evidence of systemic lupus erythematosis. He had prompt marrow recovery on drug withdrawal. While procainamide-induced agranulocytosis has been reported on a number of occasions, this is only the second case of pancytopenia.