Red cell aplasia
From IDWiki
- A form of anemia, usually acute, characterized by a lack of reticulocytosis
- Must assess for an underlying condition, including certain drugs, thymoma, hypoplastic myelodysplastic syndrome, large granular lymphocyte (LGL) leukemia, and viral infection
Diagnosis
- Normocytic, normochromic anemia (rarely macrocytic), with normal WBC and platelets
- Inappropriately very low reticulocytes (either percentage or absolute count <10)
- Normal bone marrow biopsy except for lack of erythroid precursors
Differential Diagnosis
- Idiopathic
- Drugs: phenytoin, TMP-SMX, zidovudine, chlorpropamide, recombinant epo, MMF
- Infections: parvovirus B19, HIV, viral hepatitis
- Autoimmune: AIHA, SLE, RA, ABO-incompatible transfusion
- Hematologic malignancies
- Lymphoid: CLL, LGL leukemia, HL, NHL, MM
- Myeloid: CML, agnogenic myeloid metaplasia, MDS prodrome
- Other malignancies
- Thymoma (10-15%)
- Chemotherapy-associated
- Pregnancy
Investigations
- CBC, reticulocyte count, and peripheral blood film
- Liver and renal function
- CT/MRI chest, to rule out thymoma and other neoplasms
- Viral studies, including parvovirus
- Bone marrow aspiration and biopsy
- ANA etc, as appropriate
- Depending on the suspected etiology: karyotype, T cell receptor clonality studies, peripheral blood immunophenotyping
