Question

A 18 year old male presented to the OPD with gum bleeding, fever, low TLC and low platelet count. General examination is unremarkable. Further investigation show a low reticulocyte count, absent megakaryocytes and no immature cells. Diagnosis will be?

• A. Aplastic anemia
• B. MDS
• C. PNH
• D. None

Hint:

Look for the combination of pancytopenia with absent megakaryocytes and no immature cells, pointing to bone marrow failure.

Answer 1

The Correct Option is A

Patient profile: 18-year-old male, gum bleeding, fever, pancytopenia (low TLC + low platelets), low reticulocyte count, absent megakaryocytes, no immature cells on bone marrow examination.

Diagnosis: Aplastic Anemia

Aplastic anemia is characterised by bone marrow failure resulting in peripheral pancytopenia. The marrow is replaced by fat cells, resulting in a hypocellular marrow on trephine biopsy.

Key diagnostic clues in this case:
- $Low\ reticulocyte\ count$ = marrow not producing RBCs
- $Absent\ megakaryocytes$ = marrow not producing platelets
- $No\ immature\ cells$ = not leukemia or MDS
- $Pancytopenia$ = all three cell lines affected

Causes (Acquired aplastic anemia):
- Autoimmune (T-cell mediated destruction of haemopoietic stem cells) - most common
- Drugs (chloramphenicol, NSAIDs, chemotherapy)
- Viral (hepatitis, EBV, CMV, parvovirus B19)
- Radiation

Symptoms by cell line: Anaemia (fatigue) + Neutropenia (infections, fever) + Thrombocytopenia (gum bleeding, bruising)

\[\boxed{\text{Aplastic Anemia}}\]