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