Khalid Hassan, Khalid Hassan, Lubna Naseem, Fauzia.
Erythroid and Megakaryocytic Hypoplasia Associated with Viral Bronchopneumonia in a Known Case of Beta-Thalassemia.
J Rawal Med Coll Jan ;6(1):39-40.

An eight year old female patient, diagnosed as a case of thalassaemia major at the age of six months, presented in the Medical Unit of Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, with a history of fever, cough and respiratory distress of three weeks duration. She had been on a regular blood transfusion management, every 25 to 30 days. However, in the last three months, her transfusion requirement drastically increased and she had to be transfused on three occasions during the last one month for a more rapid fall in haemoglobin level. She had been on iron chelating therapy with desferrioxamine, though irregularly and inadequately, till about a year ago, when it was stopped, mainly due to economic constraints and inconvenience. Two months back she was admitted in a hospital and treated for congestive heart failure. She was born of a non-consanguineous marriage. Out of her three siblings, one had died, probably of thalassaemia major. The other two were never screened for beta-thalassaemia trait. On examination, she was found febrile, pale and dyspnoeic. Both liver and spleen were enlarged up to 6 cms below the costal margin. Chest auscultation revealed scattered bilateral rhonchi and crepitations. A later chest X-ray showed features suggestive of bronchopneumonia. The complete blood counts at the time of admission showed: Haemoglobin 3.6G/ dl; red cell count 1.48 m/cmm; packed cell volume 12.71/l; white cell count 2,400/cmm; platelet count 22,000/cmm and reticulocyte count 0.6%. Absolute indices were as follows: MCV 85.8 fl; MCH 24.3pG; MCHC 28.3 G/dl. Red cell morphology was mainly microcytic and hypochromic with a mild macrocytosis. As indicated by pancytopenia, bone marrow aspiration was performed. The bone marrow smears were moderately hypocellular. Erythroid and megakaryocytic series were markedly hypoplastic. The residual erythropoiesis was megaloblastic. Myeloid series was moderately cellular with a shift to the left. Mild haemophagocytosis and numerous haemosiderinladen histiocytes were observed. Iron stain revealed marked iron overload. On the basis of these findings, this young thalassaemic child was diagnosed to have erythroid and megakaryocytic hypoplasia probably induced by viral bronchopneumonia.

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