Question

A 18 year old male presented to the OPD with gum bleeding, fever, low TLC and low platelet count. General examination is unremarkable. Further investigation show a low reticulocyte count, absent megakaryocytes and no immature cells. Diagnosis will be?

• A. Aplastic anemia
• B. MDS
• C. PNH
• D. None

Hint:

Look for the combination of pancytopenia with absent megakaryocytes and no immature cells, pointing to bone marrow failure.

Answer 1

The Correct Option is A

Step 1: Analyse the clinical features. An 18-year-old male presents with pancytopenia (low TLC, low platelets, gum bleeding suggesting thrombocytopenia) and fever (suggesting leukopenia-related infection risk).

Step 2: Interpret the investigation findings.
- Low reticulocyte count: Indicates hypoproliferative bone marrow (the marrow is not producing cells).
- Absent megakaryocytes: Confirms bone marrow failure; megakaryocytes produce platelets and their absence explains thrombocytopenia.
- No immature cells: Rules out leukemia (which would show blasts) and MDS (which can show dysplastic cells).

Step 3: Arrive at the diagnosis. The combination of pancytopenia + hypocellular bone marrow + absent megakaryocytes + no immature cells is the classic picture of Aplastic Anemia. The bone marrow fails to produce all cell lineages (RBCs, WBCs, platelets).

Step 4: Eliminate alternatives.
- MDS: Would show dysplastic cells and hypercellular or normocellular marrow with abnormal morphology.
- PNH: Would show hemolytic anemia features; flow cytometry would reveal CD55/CD59 deficiency.

Conclusion: Aplastic Anemia.