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Chapter 30 Aplastic Anemia 395

A

B C D
Fig. 30.1 BONE MARROW MORPHOLOGY IN SEVERE APLASTIC ANEMIA. Bone marrow biopsy
specimen, of sufficient length (A) shows severe hypocellularity. The corresponding aspirate (B, D) shows empty
marrow spicules and residual stoma including lymphoid cells, plasma cells, histiocytes and mast cells.

TABLE Differential Diagnosis of Pancytopenia TABLE A Classification of Aplastic Anemia
30.1 30.2
Pancytopenia With Hypocellular Bone Marrow Acquired Aplastic Anemia
Acquired aplastic anemia Secondary aplastic anemia
Inherited aplastic anemia (Fanconi anemia and others) Irradiation
Some myelodysplasia syndromes Drugs and chemicals
Rare aleukemic leukemia (acute myelogenous leukemia) Regular effects
Some acute lymphoblastic leukemias Cytotoxic agents
Some lymphomas of bone marrow Benzene
Pancytopenia With Cellular Bone Marrow Idiosyncratic reactions
Primary bone marrow diseases Chloramphenicol
Myelodysplasia syndromes Nonsteroidal antiinflammatory drugs
Paroxysmal nocturnal hemoglobinuria Antiepileptics
Myelofibrosis Gold
Some aleukemic leukemias Other drugs and chemicals
Myelophthisis Viruses
Bone marrow lymphoma Epstein-Barr virus (infectious mononucleosis)
Hairy cell leukemia Hepatitis virus (non-A, non-B, non-C, non-G hepatitis)
Secondary to systemic diseases Parvovirus (transient aplastic crisis, some pure red cell aplasia)
Systemic lupus erythematosus, Sjögren syndrome Human immunodeficiency virus (acquired immunodeficiency syndrome)
Hypersplenism Immune diseases
Vitamin B 12 , folate deficiency (familial defect) Eosinophilic fasciitis
Overwhelming infection Hyperimmunoglobulinemia
Alcohol Thymoma and thymic carcinoma
Brucellosis Graft-versus-host disease in immunodeficiency
Ehrlichiosis Paroxysmal nocturnal hemoglobinuria
Sarcoidosis Pregnancy
Tuberculosis and atypical mycobacteria Idiopathic aplastic anemia
Hypocellular Bone Marrow ± Cytopenia Inherited Aplastic Anemia
Q fever Fanconi anemia
Legionnaires disease Dyskeratosis congenita
Mycobacteria Shwachman-Diamond syndrome
Tuberculosis a Reticular dysgenesis
Anorexia nervosa, starvation Amegakaryocytic thrombocytopenia
Hypothyroidism Familial aplastic anemias
Preleukemia (e.g., monosomy 7)
a Pancytopenia in tuberculosis only rarely is associated with a hypocellular bone
marrow at biopsy or autopsy. Marrow failure in the setting of tuberculosis is Nonhematologic syndromes (e.g., Down, Dubowitz, Seckel)
almost always fatal; exceptional patients probably had underlying
myelodysplasia or acute leukemia.