Acquired amegakaryocytic thrombocytopenia

[dr.zhraa]

I have a case and I hope Marrow forum to add me to find the sure diagnosis.
The case:
female, 27y old, virgin, with menorhagia 3 months ago, no history of medication, there is purpura and echemotic patches on the arms and the face, no splenomegaly, but there is enlarged fatty liver by US.
CBC (wbcs 7.2, HB 6.6, Plat 10)
Blood film shows leuckoerythroblastic reaction.
BM aspiration shows slightly hypocellular BM, absent megakaryocytes, myeloid series are slightly decreased with normal morphology. Erythroid series are increased with decreased M/E ratio (1.1/1), some of them are binucleated. Lymphocytes are normal. no abnormal cells were detected.
I recmmend BM biopsy for the case
I suggest the case to be (acquirea amegakaryocytic thrombocytopenia)
is that true? and what are the other investigation I should do to that case?

[Chirley]

Have you ordered copper, zinc, B12 blood tests?

Regards

Chirley

[tytd]

In addition to what Chirley has suggested , may I ask the results of the MCV, reticulocyte count, iron stain on bone marrow,serum ferritin, iron, TIBC, folate, erythropoietin level, TSH, lupus screen? Also has the patient been on any medications or drugs that might lower platelets ? Has she ever been transfused or exposed to hepatitis C , HIV or any other recent viruses? Is the anemia simply due to blood loss from the menorrhagia caused by the low platelet count or something in addition to that? Thanks and good luck, tytd

[dr.zhraa]

Mcv 77fl, McH 23.8pg, RDW 20%, Reticulocytes 7.5%

The patient has no history of any medications or drugs.

HIV, HCV are negative.

[tytd]

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

[Neil Cuadra]

Dr. Zhraa,

I suggest that you contact the Aplastic Anemia and MDS International Foundation. They regularly provide information about bone marrow failure to physicians and they can probably put you in touch with medical professionals who can help you with this diagnosis.