Clinical Laboratory Hematology 3rd Edition by Shirlyn McKenzie, Lynne Williams

Exercise 9

Rachael, a 13-year-old female, was admitted to the hospital with complaints of progressive weakness and shortness of breath with minimal physical effort. She has experienced recurrent fevers reaching 102°F. Physical examination revealed a well-developed adolescent with good nutritional status and in no acute distress. There was no lymphadenopathy or organomegaly. Many petechial hemorrhages covered her chest and legs. Several bruises were found on her legs and thighs. Laboratory tests were ordered upon admission.
Consider the diagnostic possibilities in this case and how laboratory tests can be used to assist in differential diagnosis.
For the past 3 months, Rachael's family physician has been following her recovery from viral hepatitis. Her recovery was uneventful; her liver enzyme levels returned to normal within 2 months. She has no other past medical history. There is no family history of hematologic disorders.
Correlate Rachael's clinical findings of weakness and shortness of breath as well as petechial hemorrhages and bruises with her laboratory screening results, which follow.
Rachael was referred to a hematologist who ordered a bone marrow examination. The aspirate obtained was inadequate for evaluation due to lack of marrow spicules. Only a single site was aspirated. Touch preps made from the biopsy showed a markedly hypocellular marrow with very few hematopoietic cells. Cells present consisted of lymphocytes, plasma cells, and stromal cells. There were no malignant cells present.
Predict a treatment regimen.