Hematology Case 56

Presented By Dr Mohammad Moharram

Released on 24-11-2021

Patient Data

15 year old female

Clinical Data

History & Complain: Heavy menses 1 week ago - Dizziness and palpitation 2 days ago - Easy fatigability.

Examination: Pallor with no jaundice - Blood pressure 135/65 - Pulse 110 b/m.

Abdominal Ultrasound: No abnormal findings

Related Laboratory Results

  • CBC:

- WBC: 2.3x103 /uL (Neutrophils: 0.3x103 /uL - Lymphocytes: 1.9x103 /uL - Monocytes: 0.05x103 /uL - Eosinophils: 0.04x103 /uL - Basophils: 0x103 /uL).

- HGB: 6.9 g/dL (4.5 before blood transfusion)- MCV:74 fL -MCH: 23.7pG - MCHC: 32%

- Platelet: 22x103 /uL

  • Amylase: u/L (R.R.: 25-115) - Lipase : u/L (73-393).

  • Normal RFT & LFT

  • LDH: 124 u/L (R.R.: 98-192)

  • Serum Iron: 41 umol/L (5-30.5) - Serum Ferritin: 22 ng/mL (R.R.: 13-150)

  • Vitamin B12: 475 pg/mL (R.R.: 180-914) - Serum folate: 43 nmol/L (R.R.: 7-45).

  • Antinuclear antibodies: Positive - Anti-ds DNA (IgG): Positive

Case Picture(s) / Photo(s)

Images Comment / Findings

  • Bone marrow aspirate:

Hypocellular bone marrow; decreased all marrow elements (Myeloid , erythroid and megakaryocytic) with relative increase in lymphocytes and plasma cells (secondary to B.M. elements depression).

  • Bone marrow trephine biopsy:

Hypocellular Bone marrow for age. Estimated cellularity is <20%. All bone marrow elements are decreased. Megakaryocytes are not seen and few residual clusters of erythroid precursors are noted. The intertrabecular spaces are replaced by fat.

Final Diagnosis

Hypoplastic / aplastic pancytopenia, mostly of immune related. Furhter immunological investigations are recommended.

Additional Note

The case was referred to a higher center for further investigations and cytogenetic studies.