More Than a Haematoma: A Case of Aplastic Anemia

Abstract

Easy bruising and ecchymosis are common symptoms in clinical practice, yet distinguishing benign from clinically significant cases can be challenging. We report the case of a 46-year-old woman who presented in December 2023 with easy bruising and increased menstrual flow, revealing new-onset pancytopenia in laboratory tests. Initially diagnosed with Acute Myeloid Leukemia inversion (inv) (16), subsequent results were inconclusive, leading to a diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH). Following clinical and analytical deterioration, a repeat bone marrow study in March 2024 identified Aplastic Anemia (AA). When evaluating easy bruising and ecchymosis, a thorough history and physical examination are essential, sometimes requiring further investigation and referral. AA is a rare and heterogeneous disease that requires excluding other causes of bone marrow failure for proper diagnosis. Its severity and the patient's age determine treatment and prognosis. This case underscores the importance of investigating common symptoms that may signal serious underlying conditions, as well as the complexities involved in diagnosing AA.

Keywords: acquired aplastic anemia; bone marrow failure; bruising; ecchymosis; laboratory findings of pancytopenia; severe aplastic anemia.

Figure 1. Timeline of the most relevant events

AA – aplastic anemia; AML – acute myeloid leukemia; inv – inversion; PNH – paroxysmal nocturnal hemoglobinuria.