What is the most likely diagnosis?

A. CDA results in ineffective erythropoiesis and commonly manifests in the first decade of life with macrocytic anemia, the presence of multinucleated erythroblasts with erythroid hyperplasia, and nuclear chromatin bridges between erythroblasts in the bone marrow (noted in above images).

Three different subclasses of CDA have been identified with distinct underlying genetic abnormalities and phenotypic features. Increased iron stores are present even without blood transfusions and are thought to be due to ineffective erythropoiesis and increased intestinal iron absorption. Mutations in codanin -1 may be involved in the pathogenesis of CDA type 1. Therapy depends on the subtype and includes splenectomy, interferon alfa, and judicious use of transfusions. The presence of macrocytic anemia since infancy and lack of dysplasia affecting other blood lineages strongly argues against MDS. Increased bone marrow cellularity and preserved leukocyte and platelet counts do not fit the diagnosis of AA. DBA is also characterized by macrocytic anemia that is usually evident in the first decade oflife. However, bone marrow evaluation characteristically reveals the absence of erythroid precursors ( Curr Opin Hematol. 2000;7(2):71, Blood Rev. 1 998;1 2(3):178, Am 1 Hematol. 1996;5 1(1):55, Blood. 2008; 1 12(13):5241, Br 1 Haematol. 2005;131(4):43 1, Curr Opin Hematol. 2000;7(2):85).