↓ Figure 1. Bone marrow core biopsy at × 10.
The core biopsy shows hypocellular marrow. Cellularity is approximately 10%.
| International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc |
| Journal website https://ijcp.elmerpub.com |
Case Report
Volume 14, Number 1, June 2025, pages 1-6
Successful Treatment of COVID-19 and Multisystem Inflammatory Syndrome in Children Associated Severe Aplastic Anemia With Unrelated Donor Stem Cell Transplantation
Figures
Tables
| Test | Results |
|---|---|
| BCOR: BCL6 corepressor; BMF: bone marrow failure; C: complement; CMV: cytomegalovirus; DEB: diepoxybutane; eADA: erythrocyte adenosine deaminase; EBV: Ebstein-Barr virus; ERCC4: ERCC excision repair 4, endonuclease catalytic subunit; HemeSTAMP assay: Stanford Tumor Actionable Mutation Panel for Hematopoietic and Lymphoid Neoplasms (CPT code 81455); Hgb: hemoglobin; HHV6: human herpes virus 6; HIV: human immunodeficiency virus; HLA: human leukocyte antigen; HSV: herpes simplex virus; HTLV: human T-lymphotropic virus; LDH: lactate dehydrogenase; NK: natural killer; PNH: paroxysmal nocturnal hemoglobinuria; PT: prothrombin time; PTT: partial thromboplastin time; RBC: red blood cell; TSH: thyroid-stimulating hormone; VUS: variant of unknown significance; WBC: white blood cell. | |
| Coombs | Negative |
| Type & Screen | A+ |
| Flow for PNH | Positive (0.096%) |
| Hepatitis screen: A, B, C, E | Negative |
| Coagulation panel (s) | PTT 40.3, PT 15.4 |
| 6-panel telomeres | Normal |
| Immunoglobulins | Direct anti-platelet IgM strong positive, IgG negative; indirect antibody negative |
| T-/B-cell subsets | Decreased WBCs, NK cells, Pan B cells |
| C3, C4 | Normal |
| EBV | Past infection |
| CMV | Negative |
| HIV | Negative |
| Parvovirus | Negative |
| HHV6 | Negative |
| HSV-1, 2 | HSV-1 antibodies detected |
| HTLV-1, 2 | Negative |
| Varicella | Immune |
| HLA typing family | 5/10 match with subject |
| Hgb F | 1.1% (normal) |
| LDH/uric acid | Normal |
| Thyroid function panel (T3, T4, TSH) | Normal |
| Haptoglobin | Normal |
| BMF gene sequencing | VUS in one copy of ERCC4 |
| HemeSTAMP (blood) | BCORY497, BCORK1543fs, PIGA p.Leu175Pro variant |
| Amylase isoenzymes | Normal |
| Methylmalonic acid | Normal |
| Organic acids, urine | Negative |
| eADA | Normal |
| Flow cytometry for leukemia/lymphoma | Normal T- and B-cell populations |
| RBC folate | Normal |
| Homocysteine | Normal |
| Copper | Normal |
| Zinc | Low |
| Haptoglobin | Normal |
| DEB chromosomal test for Fanconi anemia | Negative |
| BMF panel | ERCC4 (VUS) |
| Reference | Number of patients | Hematological presentation | Age (years) | Gender | Treatment | Transplant | Comorbidity | Outcome |
|---|---|---|---|---|---|---|---|---|
| Cs-A: cyclosporine-A; Epo: erythropoietin; h-ATG: horse ATG; IST: immunosuppressive therapy; IVIG: intravenous immunoglobin; PNH: paroxysmal nocturnal hemoglobinuria. | ||||||||
| Amanati et al, 2022 [5] | 1 | Pancytopenia | 6 | F | Antibacterial and antifungal | No | None | Neutropenic enterocolitis and death due to invasive fungal infection |
| Chakravarthy et al, 2022 [6] | 2 | Severe aplastic anemia; severe aplastic anemia | 12; 18 | F; M | IST; IST with eltrombopag | No; No | None; None | Full recovery; full recovery |
| Figlerowicz et al, 2020 [3] | 1 | Severe aplastic anemia | 6 | F | IVIG, IST, antivirals, antifungals, antibiotics, convalescent plasma | No | None | Unknown |
| Lee et al, 2022 [1] | 1 | Severe aplastic anemia | 21 | M | Cs-A, eltrombopag, h-ATG, eculizumab | No | PNH | Clinical remission at 6 months |
| Mariani and Liu, 2020 [2] | 1 | Pancytopenia | 0.4 | F | Methylprednisone | No | None | Recovery in 6 weeks |
| Otieno et al, 2021 [4] | 1 | Pancytopenia | 19 | M | Eculizumab, ravulizumab | Referred for transplant | PNH | Persistent pancytopenia, unknown outcome |
| Ranjima, 2021 [7] | 1 | Aplastic anemia | 4 | F | Methylprednisone, filgrastim, Epo | No | None | Unknown |