Pure red cell aplasia and associated thymoma

Abstract

Pure red cell aplasia is a rare cause of anemia, caused by an absence of red blood cell precursors in the bone marrow. It is usually a paraneoplastic syndrome, associated most commonly with large-cell granular lymphocyte leukemia but also thymoma. For patients who present both pure red cell aplasia and thymoma, thymectomy leads to an initial remission of the aplasia in 30% of cases. However, sustained remission may require the addition of medications such as corticosteroids, cyclosporine, or cyclophosphamide. We present a case of pure red cell aplasia associated with a thymoma in an otherwise healthy 80 year-old woman.

Keywords: anemia; paraneoplastic syndrome.; pure red cell aplasia; thymoma.

Figure 1

Bone marrow biopsy of a patient with pure red cell aplasia (A) showing an abundance of myeloid cells and some megakaryocytes. Erythroid precursors are absent. Contrast with normal marrow of another patient (B) showing numerous erythroid precursors (cells with dark, round nuclei; a cluster is seen within the encircled area) (hematoxylin and eosin, 40×).

Figure 2

Computed tomography of the chest showing a mass in the anterior mediastinum (Ao, ascending aorta; Ma, mass).