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A 7 3-year-old man with anemia requiring transfusions for the past 3 mon ths presen ts for further evaluation . Leukocyte count is LJ ,900/ Jil, hemoglobin 7.9 g/dl, MCV 99 fl. platelet count 1 76,000/ Jil, and reticu locyte production index 0. 1 %. LDH is 1 82 U/L. On physical exam, he has no hepatosplenomegaly or lymphadenopathy. The peripheral blood smear is shown below.
Based on the clinical presentation, lab values, and normal appearance of the peripheral blood smear, pure red cell aplasia (PRCA) is considered. What test would be of limited benefit in the evaluation of suspected PRCA?
- CT of the chest
- Flow cytometry of peripheral blood for CD 55 and CD 59
- Viral studies including parvovirus
- Antinuclear antibodies
- TCR gene rearrangement assay
Medicine
B. Flow cytometry showing the absence of CD55 and CD59 would be consistent with a diagnosis of paroxysmal nocturnal hemoglobinuria (PNH). However, such patients usually have he-molytic anemia with reticulocytosis. The other choices are appropriate to evaluate for the presence of thymoma (CT chest), viral infections-especially parvovirus B19-the presence of autoantibodies, and TCR gene rearrangement to detect large granular lymphocytic leukemia. The latter has been re-ported to be one of the most common causes of PRCA.
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