A patient 60 year old female without any comorbidities got routine health checkup for weakness. Her complete blood count came out to be HB of 7.5 macrocytic with WBC of 3900 and platelet count of 35000. As she was suffering from acidity her doctor advised her vit B12 injection suspecting pernicious anemia. Her B12 level were 194( low normal). her iron and folic acid level were normal. She underwent bone marrow biopsy which showed hypocellularity with very few megakaryocytes.
Cellularity was 20-25 percent. there were no blasts, myelofibrosis or any other lesions.she had dry cough sine 10 days before getting routine checkup. Her hemoglobin kept dropping each week by 0.5 and reached 6.1 after 4 weeks when she required transfusion. Her platelet count fluctuated between 15000-30000. her WBC count fluctuated between 3500-4000. She consulted 4 hematologist and each gotbher bone marrow slides…
