Acquired Amegakaryocytic Thrombocytopenia and Pure Red Cell Aplasia as Initial Presentation Of Thymoma
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Publication Date
4-29-2026
Keywords
oregon, ppmc, ppmc gme
Disciplines
Medical Education
Abstract
Introduction: Pure Red Cell Aplasia (PRCA) is a common feature of thymomas, but it rarely presents with acquired amegakaryocytic thrombocytopenia (AAMT). Here, we present a case of a 59-year-old male with fatigue found to have severe anemia and thrombocytopenia, who was eventually diagnosed with a thymoma Case Presentation: Found to have Hg of 6.1 g/dL and platelet count of 33 k/uL; Reticulocyte count was 0.0068. CT chest showed an anterior mediastinal mass measuring 4.5 x 6.6 cm. Mass biopsy showed thymoma. Bone marrow biopsy showed 50% cellularity with absence of erythroid and megakaryocyte precursors compatible with AAMT and PRCA. At presentation, patient required pRBC and platelet transfusion every 2 days. Initiated on a combination of steroids and cyclosporine A (CsA). Thymectomy was performed on day 61. Successfully tapered off steroids and CsA by day 114 and day 152, respectively. He did suffer one relapse on day 244, for which he was treated with Anti-thymocyte globulin (ATG) with CsA and prednisone which has provided a response Discussion: AAMT and PRCA have been described in patients with thymoma both prior to diagnosis and persisting/relapsing years after resection. These are thought to be immunologically mediated phenomena. Options for treatment comprise CsA and steroids as for our patient. For our patient,CsAand steroid therapy continued before and after surgery on day 61, which led to continued stabilization of blood counts. It is thought that AAMT may be an early presentation of aplastic anemia. For our patient, ATG, CsA, and steroid, have stabilized his counts Conclusion: PRCA and AAMT may present together in cases of thymoma. Early detection of the hematological disorders via bone marrow biopsy will help lower the risk of progression to aplastic anemia. Treatment with both cyclophosphamide and steroid taper before and after the thymectomy may minimize the number of relapses of the disorders and transfusions required for the patient
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Internal Medicine
