An 18 year old adult presents to your office with complaints of fever, fatigue and lethargy for 1 week duration. He also gives you a history of fever, sore throat and numerous swellings around his neck 3 weeks back and it resolved spontaneously. He has no other complaints. On examination, his vitals are:     P- 100bpm, BP- 110/80 mmHg, temp.- 1000F, RR- 20/min. On general examination, you observe purpuric and ecchymotic rashes on the anterior of shin, thigh and trunk. His liver and spleen are not palpable. How will you proceed with the management of this case?

  • Pancytopenia with hypocellularity (aplasia) of the bone marrow; there are no leukaemic, cancerous or other abnormal cells in the peripheral blood or bone marrow. 
  •  inherited and acquired.
  • Reduction in the number of pluripotential stem cells
  • Failure of only one cell line e.g. RBCs results  in pure red cell aplasia. 
  •  Myelodysplasia, paroxysmal nocturnal haemoglobinuria (PNH) or acute myeloblastic leukaemia occurs in some cases due to an abnormal clone of haemopoietic cells.
  • Activated cytotoxic T cells in blood and bone marrow are responsible for the bone marrow failure.
Causes of aplastic anaemia

  • Congenital, e.g. Fanconi's anaemia 
  • Idiopathic acquired (67% of cases) 
  • Chemicals, e.g. benzene 
  • Drugs: 
  • chemotherapeutic 
  • idiosyncratic reactions 
  • Insecticides
  • Ionizing radiation 
  • Infections: 
  • viral, e.g. hepatitis, EBV, HIV, parvovirus 
  • other, e.g. tuberculosis 
  • Paroxysmal nocturnal haemoglobinuria 
  • Miscellaneous, e.g. pregnancy 
  • Busulfan ,doxorubicin, chloramphenicol, gold, carbimazole, chlorpromazine, phenytoin, tolbutamide, non-steroidal anti-inflammatory agents, 
  •  Gene mutations e.g. the telomerase RNA component, in one third of aplastic anaemias. 
  • Fanconi's anaemia ,inherited as an autosomal recessive, is associated with skeletal, renal and central nervous system abnormalities, ages of 5 and 10 years. 
Clinical features
  • Anaemia, bleeding and infection(oral). 
  • Bruising with minimal trauma or blood blisters in the mouth. 
  • Physical findings include ecchymoses, bleeding gums and epistaxis. 
  • Lymphadenopathy and hepatosplenomegaly are rare.
  • Peripheral smear
  • pancytopenia 
  • the virtual absence of reticulocytes 
  • a hypocellular or aplastic bone marrow with increased fat spaces
Causes of pancytopenia
  • Aplastic anaemia
  • Drugs 
  • Megaloblastic anaemia 
  • Bone marrow infiltration or replacement   
  • Hodgkin's and non-Hodgkin's lymphoma
  • Acute leukaemia   
  • Myeloma
  • Myelofibrosis 
  • Hypersplenism 
  • Systemic lupus erythematosus
  • Disseminated tuberculosis 
  • Paroxysmal nocturnal haemoglobinuria 
  • Overwhelming sepsis
Treatment and prognosis

Supportive care, specific treatment
Treatment of infection – if any.
Immediate institution of broad-spectrum parenteral antibiotics in neutropenic patient – prophylactic in all cases.
Supportive care: transfusions of red cells and platelets

A bad prognosis (i.e. severe aplastic anaemia) if two of the following three features:
neutrophil count of less than 0.5 × 109/L
platelet count of less than 20 × 109/L
corrected reticulocyte count less than 1% (or absolute reticulocyte count less than 60,000/L).
Survival of patients  is about 20% at 1 year after diagnosis with  supportive care;

Suspect exposures to drugs or chemicals should be discontinued;


Treatment of choice for patients under 40 years of age who have an HLA-identical sibling donor, which gives a 75-90% chance of long-term survival, restores the blood count to normal.
Immunosuppressive therapy  for patients without HLA-matched siblings and over the age of 40 years; antilymphocyte globulin (ALG) and ciclosporin in combination(60-80%).

Androgens (e.g. oxymethalone)
Steroids   are  used in children with congenital pure red cell aplasia (Diamond-Blackfan syndrome).
Adult pure red cell aplasia is associated with a thymoma in 30% of cases and thymectomy may induce a remission.


  1. mbbs in Philippines
    Every year, almost 8000 foreign students take admission in Philippines Medical universities and out of which around 50% are Indian students. The standard of education in Philippines universities is well known around the world. Thousands of doctors from these medical universities are sent to various countries like USA and UK every year. There are around 2299 higher educational institutions and 40 medical colleges. The main benefits of pursuing MD degree from

    Top Medical Colleges in Philippines :


    Top Searched Topics on MBBS in Philippines

    study mbbs in philippines
    philippines medical colleges list
    best medical colleges in philippines for indian students
    philippines medical colleges
    best medical colleges in philippines
    mci approved medical colleges in philippines

    for more information contact us : +91 90329 55688

  2. UV GULLAS COLLEGE OF MEDICINE is one of Top Medical College in Philippines in Cebu city. International students have the oppertunity to study medicine in phillipines at affordable cost and world class University. The college has successful alumni who have achieved well in the fields of law, business, politics, academe, medicine, sports and other endeavors. At University of the Visayas, we prepare students for a global competition.

    Direct MBBS Admissions Open: 2020-21
    Mobile No: +91 90329 55688
    Apply Now: https://www.careerplus.org.in/philippines-medical-college/uv-gullas-college-of-medicine

  3. MBBS in Philippines Wisdom Overseas is authorized India's Exclusive Partner of Southwestern University PHINMA, the Philippines established its strong trust in the minds of all the Indian medical aspirants and their parents. Under the excellent leadership of the founder Director Mr. Thummala Ravikanth, Wisdom meritoriously won the hearts of thousands of future doctors and was praised as the “Top Medical Career Growth Specialists" among Overseas Medical Education Consultants in India.

    Why Southwestern University Philippines
    5 years of total Duration
    3D simulator technological teaching
    Experienced and Expert Doctors as faculty
    More than 40% of the US returned Doctors
    SWU training Hospital within the campus
    More than 6000 bedded capacity for Internship
    Final year (4th year of MD) compulsory Internship approved by MCI (No need to do an internship in India)
    Vital service centers and commercial spaces
    Own Hostel accommodations for local and foreign students
    Safe, Secure, and lavish environment for vibrant student experience
    All sports grounds including Cricket, Volleyball, and others available for students


Popular Posts