A Case of Severe Aplastic Anemia in a 35-Year-Old Male With a Good Response to Immunosuppressive Therapy

Abstract

Aplastic anemia (AA) is a severe but rare hematologic condition associated with hematopoietic failure leading to decreased or total absent hematopoietic precursor cells in the bone marrow. AA presents at any age with equal distribution among gender and race. There are three known mechanisms of AA: direct injuries, immune-mediated disease, and bone marrow failure. The most common etiology of AA is considered to be idiopathic. Patients usually present with non-specific findings, such as easy fatigability, dyspnea on exertion, pallor, and mucosal bleeding. The primary treatment of AA is to remove the offending agent. In patients in whom the reversible cause was not found, patient management depends on age, disease severity, and donor availability. Here, we present a case of a 35-year-old male who presented to the emergency room with profuse bleeding after a deep dental cleaning. He was found to have pancytopenia on his laboratory panel and had an excellent response to immunosuppressive therapy.

Keywords: anti-thymocyte globulin (atg); eltrombopag; hypocellular bone marrow; paroxysmal nocturnal hemoglobinuria (pnh); severe aplastic anemia.

Figure 1. Bone marrow aspiration is aparticulate and markedly hypocellular, 5-10% cellularity consistent with aplastic anemia. No abnormal cells were seen.

Figure 2. Bone marrow trephine biopsy shows a hypocellular marrow, which was replaced mainly with nonhematopoietic tissues, such as fat.