A CBC shows severe pancytopenia with Hgb 68 g/L, WBC 1.2 × 10^9/L, platelets 15 × 10^9/L, and bone marrow described as hypocellular with a dry tap. What is the presumptive diagnosis?

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Multiple Choice

A CBC shows severe pancytopenia with Hgb 68 g/L, WBC 1.2 × 10^9/L, platelets 15 × 10^9/L, and bone marrow described as hypocellular with a dry tap. What is the presumptive diagnosis?

Severe pancytopenia with a hypocellular marrow and a dry tap is classic for aplastic anemia. In this condition, hematopoietic stem cells are destroyed or suppressed, so the marrow becomes markedly low in cellularity and is often replaced by fat. Because there are very few cells to aspirate, the bone marrow aspirate can yield little or no material—a dry tap. The blood picture reflects this failure of production: very low red cells, white cells, and platelets. Leukemia would more typically show a hypercellular marrow with increased blasts. Myelodysplastic syndrome can cause cytopenias, but the marrow is usually dysplastic and often hypercellular with cytogenetic abnormalities. Paroxysmal nocturnal hemoglobinuria can cause pancytopenia due to marrow failure, but the dry tap and the characteristic hypocellular marrow with fatty replacement point most strongly to aplastic anemia.

Severe pancytopenia with a hypocellular marrow and a dry tap is classic for aplastic anemia. In this condition, hematopoietic stem cells are destroyed or suppressed, so the marrow becomes markedly low in cellularity and is often replaced by fat. Because there are very few cells to aspirate, the bone marrow aspirate can yield little or no material—a dry tap. The blood picture reflects this failure of production: very low red cells, white cells, and platelets.

Leukemia would more typically show a hypercellular marrow with increased blasts. Myelodysplastic syndrome can cause cytopenias, but the marrow is usually dysplastic and often hypercellular with cytogenetic abnormalities. Paroxysmal nocturnal hemoglobinuria can cause pancytopenia due to marrow failure, but the dry tap and the characteristic hypocellular marrow with fatty replacement point most strongly to aplastic anemia.

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