Acquired Pure Red Cell Aplasia Associated with Thyroid Carcinoma: Case Report

A. Iannucci, A. Perini, G. Pizzolo, Cattedra di Ematologia and Istituto di Anatomia, Patologica, Padova University, I-37134 Verona (Italy) To the Editor, We would like to draw the attention of your readers to the following case report. A 64year-old woman was referred to our hospital with a 2-year history of weakness. On admission she was pale without any other relevant findings at physical examination. Haemoglobin was 7.3 g/dl, platelets 160 × 10V1, and WBC 9.4 × 10V1 with a normal differential count. Reticulocyte count was 0.5%. Bone marrow smears showed an almost complete absence of erythroblasts with normal myelopoiesis and megakaryopoiesis. All other routinary biochemical tests were normal with the exception of ESR which was increased. A diagnosis of pure red cell aplasia (PRCA) was made and the patient received repeated blood transfusions. Mediastinal tomograms performed to search for a thymo-ma revealed a mild mediastinal enlargement; the patient underwent mediastinoscopy and a biopsy was performed. The histological examination revealed a lymph nodal metastasis from the medullary carcinoma of the thyroid. This diagnosis was confirmed on the thyroid gland which was almost completely involved by the tumor when a hemithyroidectomy was carried out. Repeated blood counts and bone marrow examinations, following surgery, confirmed the diagnosis of PRCA and no improvement was observed. Blood transfusion requirement was unchanged and the patient died at home 7 months later of unknown cause. Correspondence 63