Part 1: Aplastic Anemia
Gabrielle Meyers, MD
Assistant Professor of Medicine, Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR.
A hematologist is called urgently by an obstetrician for a consultation regarding a 26-year-old woman who is 20 weeks pregnant and has significant pancytopenia. Her pregnancy to date has been uncomplicated, and she contacted her obstetrician for an evaluation after she developed shortness of breath with exertion, dizziness, and easy bruising. She looked pale in the office, with non-stress testing showing no significant problems with the fetus. Her blood counts revealed a WBC of 2400 cells/ÁL; hemoglobin, 7.8 g/dL; platelet count, 18,000 cells/ÁL; WBC differential, 22% segmented neutrophils, 74% lymphocytes, 4% monocytes. Serum chemistry studies show normal liver function tests, normal electrolytes and renal function, and an elevated lactate dehydrogenase level at 220 U/L.
What is the most likely diagnosis in this patient?