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Clinical Case 19
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An 18-year-old college student presents to your office complaining of fatigue. He is on the soccer team and has noticed decreasing exercise tolerance and dyspnea when climbing the stairs in his dormitory. He has no prior significant medical history and takes no medications. He does not smoke and drinks approximately 6 alcoholic beverages per week. Physical examination is unremarkable with the exception of pallor and a resting pulse of 110. You obtain a CBC: WBC 1,100/mm3, 400/mm3 neutrophils, hemoglobin 6.8 g/dl, and platelet count 15,000/mm3. His peripheral blood demonstrates no blasts, and his vitamin B12 and folate levels are normal. His bone marrow is 10% cellular.



1

Which of the following must be excluded before making a final diagnosis of idiopathic aplastic anemia?
A)Drug effects.
B)Anorexia nervosa.
C)Viral infections.
D)Inherited disorders such as Fanconi anemia.
E)All of the above







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