Aplastic Anaemia — RACP Adult Medicine MCQ

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ModerateHaematologyAplastic AnaemiaRACP Adult Medicine

A 20-year-old man presents with pancytopenia (Hb 65 g/L, WCC 1.5 × 10⁹/L, platelets 12 × 10⁹/L). Blood film shows no abnormal cells. Reticulocyte count is very low. Bone marrow biopsy is hypocellular (<20% cellularity) with fat replacement. Cytogenetics are normal. He has no splenomegaly. What is the most likely diagnosis?

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Correct answer: B — Aplastic anaemia

Pancytopenia with hypocellular bone marrow (<25% cellularity), absent abnormal cells, low reticulocytes, and normal cytogenetics is aplastic anaemia. It may be idiopathic (autoimmune T-cell mediated) or secondary (drugs, viruses, radiation). Treatment for severe AA in young patients: allogeneic SCT (if matched sibling donor) or immunosuppressive therapy (ATG + ciclosporin). Eltrombopag is added upfront per RACE trial.

Reference: BSH – 2024 – Aplastic Anaemia; ALLG 2024