A 17-YEAR-OLD ADOLESCENT GIRL WITH PANCYTOPENIA: DIAGNOSTIC CHALLENGES IN DIFFERENTIATING REFRACTORY IMMUNE THROMBOCYTOPENIA FROM SEVERE APLASTIC ANEMIA

Abstract

This needs to be determined since the medical problem involves an adolescent patient with pancytopenia, which may arise from immune-mediated cytopenias or bone marrow failure syndrome. We report the case of a 17-year-old previously healthy adolescent girl who arrived at the hospital with severe menstrual bleeding, petechiae, and bruising; she needed blood transfusions to treat her pancytopenia. The doctors treated her first for ~~refractory immune thrombocytopenia (ITP), a provisional diagnosis of ITP using corticosteroids and eltrombopag, but she did not achieve any enduring results. The bone marrow biopsy showed hypocellularity at 35–40%, megakaryocytic hypoplasia, trilineage suppression, and MF-2 grade reticulin fibrosis, confirming severe aplastic anemia (SAA). The medical practitioners administered supportive care through blood transfusion, in addition to eltrombopag medication. The medical practitioners then started evaluating her eligibility for Hematopoietic Stem Cell Transplantation (HSCT). Moreover, this case highlights that pancytopenia with bleeding symptoms requires prompt bone marrow examination to distinguish ITP from SAA, as treatment approaches differ fundamentally.