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A 3LJ-year-old female with anorexia nervosa (AN) is referred by her primary care physician for further evaluation of anemia and thrombocytopenia. Physical examina tion reveals an underweight and malnourished young female in no acute distress. Lab oratory workup shows leukocyte count 9.000/pl. hemoglobin 7.9 g/dl. mean corpuscular volume (MCV) 101 fl. and platelet count 60.000/pl. Peripheral blood smear confirms the presence of thrombocytopenia. but shows no other gross abnor malities. Bone marrow biopsy is obtained and is shown below.
What is the most likely explanation for her presentation?
- Aplastic anemia (AA)
- Folate deficiency
- Vitamin B12 deficiency
- Gelatinous degeneration
- Myelofibrosis (MF)
Medicine
D. Bone marrow biopsy reveals the presence of an amorphous gelatinous eosinophilic infil trate that replaces the normal hematopoietic elements. Hematologic abnormalities are common in patients with AN, and gelatinous degeneration of bone marrow has been reported in 50% of cases. AA would not be expected to exhibit the abnormal bone marrow infiltrate seen in this case. Although vitamin B12 and folate deficiencies are possible, they would not account for the bone marrow picture. MF presents with evidence of leukoerythroblastosis in the peripheral blood, and the bone marrow infiltrate seen in this case is not characteristic of bone marrow fibrosis seen with MF (Int J Eat Disord. 2009;42(4):293, Am J Clin Pathol. 2002;118(4):582, Arch Intern Med. 2005;165(5):561).
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