A 5 6-year-old female presen ts for evaluation of pancytopenia after presenti ng to her primary care physician, complai ning of 3 mon ths of fatigue and bleeding gums. Patient den ies preceding ill nesses and has not been taking any new medications . Physical ex- amination shows no lymphadenopathy or hepatosplenomegaly. Labora tory workup is sign i ficant for a hemoglobin of 6 g/d l. reticulocyte i ndex of 0.5%, mean corpuscular volume of 97 fl. total leukocyte count of 2.300/,uL, absolute neutrophil count of 1 , 1 00/,uL, and platelet count of 1 2 ,000/,uL. Bone marrow b iopsy is obtai ned and no ch romosomal abnormalities are detected . Peripheral blood smear and bone marrow biopsy are shown below.
Which form of ATG is more effective in the management of AA?
- Horse ATG (h-ATG)
- Rabbit ATG (r-ATG)
- Both have equal efficacy
- There are no available data
Medicine
A. Studies show that the use ofh-ATG is associated with higher response rates and survival compared with r-ATG (NEJM. 201 1;365(5):430, Blood. 201 2;119(23):5391).
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