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BONE MARROW FAILURE! Hemoglobin of 4 gm/dl and Reticulocytes of < 0.5%

September 22, 2017




High Yield Review - Aplastic Crisis 

Case: A 23 y/o African American female with a 

medical history of sickle cell anemia, comes to 

the emergency department for evaluation of

shortness of breath, fatigue, and 

light headedness. She also c/o joint pains in her hands and ankles.  All of  her symptoms have been worsening over  

the past week. She states her baseline hemoglbin is 10 gm/dl.

And she has not had a blood transfusion in many years.

She has pale conjunctiva, and no rash noted, no spleenomegaly noted. 


Her Stat Hemogram shows

Hemoglobin of 4 gm/dl ( Her baseline is 10 )


Reticulocytes of 0.5% ( Normal 0.5- 2.5%) 


You send for a type and cross, request for packed red blood cells,

and inform the nurse that they patient will need a blood transfusion and supportive care. The patient was also started on IV Fluids, and Oxygen via nasal cannula. 



Case Clues - Aplastic Crisis in Sickle Cell 

- She has a h/o of sickle cell anemia and her symptoms are worsening, implying an acute worsening on chronic anemia

- Very low Hemoglobin of 4 gm/dl from her baseline of 10 gm/dl

- Very low Reticulocytes of < 0.5 % 

- Joint Pains 

- No Recent Blood Transfusions 


Notable Notes - Aplastic Crisis in Sickle Cell 

- Hall mark is decrease in bone marrow -->

Decrease in Erythropoiesis --> Low Hemoglobin and Low Reticulocytes 

- The culprit is INFECTIONS: ( Parvo B19, EBV,  Staph.Pneumonia and Salmonella) 

- Parvo B19 Infection is adults mostly p/w joint pains, no rash

- Treatment is supportive ( Blood Transfusions, IV Fluids, Oxygen )


The Differentials ( Why Not? ) 


Why not Splenic Sequestration Crisis ? 

--> Will have Low Hemoglobin 

--> Will have Elevated Reticulocytes 

--> Spleenomegaly 

--> Common in Children ( This patients an adult ) 


Why not Hemolytic Crisis ?

--> Will have low hemoglobin

--> Will have Elevated Reticulocytes 

--> No h/o recent massive blood transfusions 



Know it for the Boards- Aplastic Crisis in Sickle Cell!  

- Acute worsening of Anemia in a adult with Sickle Cell suspect

Aplastic Crisis 

- Clues for Aplastic Crisis is Low Hemoglobin and  Low Reticulocytes 

-Aplastic Crisis think INFECTION! 





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