Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Hematology


Answer 2



Figure.

  1. Aplastic anemia. The bone marrow sample shows no marrow elements and no evidence of dysplasia (Figure). This patient meets criteria for very severe aplastic anemia, with profound neutropenia (ANC < 200 cells/µL), thrombocytopenia (platelet count < 20,000 cells/µL), and marrow cellularity less than 25%. Work-up of aplastic anemia, including viral studies and thorough review of drugs, herbal products, and exposures to chemicals (eg, benzene) and radiation, is necessary. Most cases of aplastic anemia are idiopathic. In idiopathic aplastic anemia, the immune system is thought to cause the destruction of hematopoietic elements. As a result, treatment options include bone marrow transplantation or immunosuppression. The World Health Organization (WHO) criterion for acute leukemia is a blast count of over 20% in the marrow; this patient’s marrow has no evidence of an elevated blast count, making the diagnoses of acute lymphoblastic leukemia and AML unlikely. Also, in acute leukemias, the marrow is usually hypercellular as opposed to hypocellular. Typically, patients with MDS have an elevated cellularity in the bone marrow, and dysplasia is present in more than 1 cell line. However, it is often difficult to distinguish hypocellular MDS from aplastic anemia, particularly in older patients. To consider hypocellular MDS as a diagnosis, cytogenetic abnormalities and/or evidence of dysplasia on the bone marrow specimen should be present.

    Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 2/05/2009 • nvf