A 52-year-old female data entry worker complained of bilateral wrist pain. Her physician prescribed a non-steroidal anti-inflammatory drug. Her wrist pain improved; however, over the next 3 months, she noted increasing fatigue and scattered bruises. Past medical history was normal. She was taking no other medications and had no recent chemical exposure. Physical examination revealed pallor and scattered ecchymoses (skin coloration) with petechiae on her chest and shoulders with no other abnormalities.

Complete blood count results were as follows:

WBC 2 X109/L

MCV 104fL

Hb 8 g/dl

Platelets 27 X109/L

Reticulocytes 0.6%

Reticulocytes 16 X 109/L

Neutrophils 1.1 X 109/l

Lymphocytes 0.4 X 109/L

Serum B12 and folate levels were normal

Bone marrow aspirate was normocellular with dyserthropoiesis but, normal myelopoiesis and Megakaryopoiesis. Iron stain shows normal stores. However, the bone marrow biopsy was moderately Hypocellular (30%) with a reduction in all three-cell lines. There are no increases in Reticulin.

Cytogenetic testing shows a normal karyotype and results of flow cytometry for PNH cells was negative.

1-What term is used to describe a decrease in all cell lines in the peripheral blood?

2-Which anemia of bone marrow failure should be considered (Hereditary/ Acquired)? Why you choose this type?

3- In which other diseases would an increase in either Reticulin and blasts will be noticed?

4-How would the severity of this patient’s condition be classified (Server/ non-severe)? Why?

5-What treatment modality would be considered for this patient?​