Hello Dr. Zahrr,
You may be right about the amegakaryocytic thrombocytopenia and I would agree with a bone marrow biopsy. Could it be ITP?, but would expect more megakaryocytes in the bone marrow with that. Do you think that she has iron deficiency anemia from the blood loss or does she have any thalassemia too which would account for the low MCV and reticulocytosis? If the diagnosis remains in doubt and you wish to get advice about treatment decisions, I would suggest that you try e-mailing Neal Young at the NIH
youngns@mail.nih.gov. He is an expert on rare bone marrow diseases. Let us know how she does and what you decide? Thanks tytd