Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

150 Aplastic Anemia

Aplastic Anemia.....................................

ROBERT A. BRODSKY, MD

history & physical

History

■Drugs (anti-epileptics, chloramphenicol, etc.) account for <10% of

cases.

■viruses (EBV, seronegative hepatitis, etc.)

■benzene

■radiation

■idiopathic (> 80% of cases)

Signs & Symptoms

■anemia (fatigue, dyspnea), thrombocytopenia (petechiae, easy

bruising, bleeding), neutropenia (fever/infection)

➣Family history of cytopenias

tests

■CBC with differential× 2

■Reticulocyte count

■Bone marrow aspirate and biopsy

■Bone marrow cytogenetics

➣Bone marrow CD34 count

■Liver enzymes

■HLA typing

■Chromosomal breakage studies (DEB) in patients <40 years old

■Flow cytometry (CD59 or FLAER) for paroxysmal nocturnal hemo-

globinuria (PNH)

differential diagnosis

■MDS (cytogenetics, morphology, flow cytometry)

■PNH (flow cytometry for loss of GPI-anchors, aerolysin-based

assays)

■Fanconi anemia (chromosomal breakage studies, DEB)

■Hairy cell leukemia

➣Dyskeratosis congenita

management

What to Do First

■transfuse only if symptomatic