Case 99 – update 3

A bone marrow biopsy has been carried out: (see below)

Aspirate shows erythroid hypoplasia but no dysplastic features. Cellularity is normal and megakaryocyte & granulocyte lineages are normal.

For interest, also see Trephine IHC with Glycophorin-C staining – demonstrating reduced but organised erythropoiesis.

Parvovirus serology is negative, EMA is normal, but eADA is elevated.

HbF 14% (elevated).

Mutational analysis has been sent.

It is now 2 weeks since her first transfusion.

Questions:

1. What is your preferred diagnosis? What other differentials have you ruled out?

2. What treatment strategy would you employ at this point & why?

2. What can you do to minimise any problems from your treatment of choice?

3. What other investigations should be carried out in this patient based on your diagnosis?

Join us on Twitter @TeamHaem and let us know what your thoughts are, what questions you have and what you want to do as we see this case evolve over the next week.

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