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首页> 外文期刊>BMC Psychiatry >Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
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Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report

机译：模仿特发性再生障碍性贫血的神经性厌食症相关的全血细胞减少症：一例报告

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Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia from other types of pancytopenia, especially idiopathic aplastic anemia (IAA), has not been studied. We encountered a case of pancytopenia in a patient with AN and relatively poor nutritional status, whose hematological findings mimicked those of IAA, specifically fatty bone marrow and absence of GMT. The patient was a 32-year-old woman with poorly controlled AN. At 31?years of age, her body mass index (BMI) had fallen from 17.0?kg/m2 to below 13.8?kg/m2. The patient presented with ongoing fatigue and thus was examined by a hematologist. Hematological findings were consistent with IAA: peripheral blood tests revealed pancytopenia, whereas the bone marrow displayed fatty replacement without GMT. Despite the absence of bone marrow features typically seen in malnutrition, the patient’s hematological abnormalities had manifested after a decrease in body weight. Thus, although the bone marrow findings indicated IAA, we considered that the nutritional etiology of pancytopenia could not be thoroughly ruled out. Using nutritional therapy alone, the hematological abnormalities improved as BMI increased to 16.5?kg/m2. The final diagnosis was pancytopenia secondary to malnutrition because pancytopenia and fatty bone marrow improved after implementation of nutritional therapy alone. The present case is the first documented case of AN with pancytopenia for which bone marrow examination confirmed fatty marrow without any evidence of GMT. IAA and pancytopenia secondary to malnutrition can present the same clinical findings. This case is significant because it suggests a need to differentiate between malnutrition and IAA.
机译：神经性厌食症（AN）患者常表现为全血细胞减少症。在文献中描述的大多数情况下，全血细胞减少症的AN表现为凝胶状骨髓转化（GMT），这是营养不良的典型骨髓特征。尚未研究与AN相关的全血细胞减少症与其他类型的全血细胞减少症，特别是特发性再生障碍性贫血（IAA）的区别。我们在一名营养不良且营养状况相对较差的患者中遇到了一例全血细胞减少症，其血液学发现与IAA相似，特别是脂肪骨髓和缺乏GMT。该患者是一名32岁女性，AN控制不佳。在31岁时，她的体重指数（BMI）从17.0？kg / m2降至13.8？kg / m2以下。该患者表现出持续的疲劳感，因此接受了血液学家的检查。血液学检查结果与IAA一致：外周血检查显示全血细胞减少，而骨髓显示无GMT的脂肪替代。尽管缺乏营养不良中常见的骨髓特征，但体重减轻后仍表现出患者的血液学异常。因此，尽管骨髓的发现表明IAA，但我们认为不能完全排除全血细胞减少症的营养病因。仅使用营养疗法，血液异常就随着BMI增至16.5？kg / m2而改善。最终诊断为营养不良继发的全血细胞减少症，因为仅实施营养治疗后全血细胞减少症和脂肪骨髓得到改善。本病例是第一例有全血细胞减少症的AN患者，其骨髓检查证实为脂肪性骨髓，没有任何GMT证据。营养不良继发的IAA和全血细胞减少症可表现出相同的临床发现。这种情况很重要，因为它表明需要区分营养不良和IAA。

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