Hemodialysis inadequacy affects not only morbidity and mortality of the dialysis patients, but it can also reduce the effectivity of therapies such as rHuEPO. Hemodialysis inadequacy and erythropoietin ineffectivity are the essential problems of the physicians who deal with patients who have end stage renal failure, and they reduce treatment success. We report a rarely seen case who has pancytopenia because of hemodialysis inadequacy and/or rHuEPO ineffectivity.