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Pure Red Cell Aplasia Workup

  • Author: Paul Schick, MD; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Feb 25, 2014
 

Laboratory Studies

CBC count, RBC indices, a reticulocyte count, and a differential analysis of WBCs should be obtained.

Iron studies, especially iron saturation and serum ferritin levels, are used to diagnose hemosiderosis. This possibility should be considered in patients who have received multiple transfusions.

Serum vitamin B-12 and folate levels might be indicated in patients with macrocytosis.

Lactate dehydrogenase (LDH), indirect bilirubin, and serum haptoglobin levels are used to detect hemolysis.

Hemoglobin A2 and hemoglobin F are used to rule out thalassemia.

Flow cytometry is used to diagnose hematological malignancies and T-cell disorders.

Tests to identify parvovirus B19 infection,[26] hepatitis, infectious mononucleosis, and other infections are indicated.

Tests to detect autoimmune disorders should include an antinuclear antibody test, a C-reactive protein (CRP) level, an erythrocyte sedimentation rate (ESR), a quantitative immunoglobulin analysis, and a direct Coombs test to detect an autoimmune hemolytic anemia. Tests for thyroiditis, diabetes, rheumatoid arthritis, Sjögren syndrome, and SLE might be indicated.

Hemoglobin F, “I” on the surface of erythrocytes, and adenosine deaminase determinations are helpful in diagnosing Diamond-Blackfan syndrome.

Bone marrow histology

Peripheral smears demonstrate a normocytic anemia in most cases of PRCA. However, macrocytic anemia occurs in Diamond-Blackfan and Good syndromes and in HIV infections. Peripheral smears can be used to screen for infectious mononucleosis, megaloblastosis, and hematological malignancies.

Bone marrow aspiration smears in pure red cell aplasia (PRCA) usually reveal a normocellular marrow. An absence of erythroblasts is noted, whereas more immature erythrocyte progenitors are present (maturation arrest). WBCs and platelet maturation are normal. Bone marrow can be used to evaluate iron stores and help diagnose megaloblastosis and hematological malignancies.

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Imaging

Positron emission tomography (PET) and CT scans are used to detect thymomas.

Spleen size can be determined by ultrasound imaging.

Appropriate imaging studies are used to help diagnose and evaluate hematological malignancies.

Duel-energy x-ray absorptiometry scans are used to assess osteopenia and osteoporosis due to corticosteroid therapy.

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Procedures

Procedures can include (1) bone marrow aspiration and biopsy and (2) appropriate biopsies to diagnose hematological malignancies.

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Contributor Information and Disclosures
Author

Paul Schick, MD Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

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