A 27-year-old man presents with bleeding gums and easy bruising. He also states that he has felt very tired lately and has had recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his symptoms started after that.

His full blood count today is as follows:

  • Hb 5.4 g/dl (11.5-14 g/dl)
  • MCV 89 fl (80-100 fl)
  • WCC 1.1 x 109/l (4-11 x 109/l)
  • Platelets 17 x 109/l (150-450 x 109/l)
  1. What is the most likely diagnosis?
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This patient is highly likely to have a diagnosis of aplastic anaemia.

Aplastic anaemia is a rare, potentially life-threatening failure of haemopoiesis characterised by pancytopenia and hypocellular bone marrow.  It results from damage to the bone marrow and the haematopoietic stems cells that reside there. It results in a deficiency of all three blood cell types (pancytopaenia): red blood cells, white blood cells, and platelets.

  1. What are the main causes of this condition?
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The causes of aplastic anemia include:

  • Autoimmune
  • Drug induced e.g. sulphonamide antibiotics, phenytoin, propylthiouracil
  • Viral e.g. EBV, parvovirus
  • Chemotherapy
  • Radiotherapy
  • Inherited – Fanconi anaemia
  1. How do patients with this condition generally present?
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Patients with aplastic anaemia generally present with features of anaemia, recurrent infections secondary to a low white cell count and increased bleeding tendency secondary to low platelets.

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