History A premature infant male was born to a multiparous mother. Early in the mother's pregnancy, routine prenatal screening identified fetal anemia requiring multiple percutaneous umbilical blood sampling (PUBS) procedures and fetal transfusions. A workup for immune mediated causes of fetal anemia was completely negative. During one PUBS procedure, the fetus showed a significant cardiac deceleration, leading to an emergent C-section.
His immediate post-delivery course was complicated by multiple prematurity associated comorbidities, as well as unexplained persistent anemia without reticulocytosis which required transfusion support. Hematology was consulted for the persistent anemia and a bone marrow aspirate and biopsy was recommended. Pathological features The patient's peripheral blood smear showed only nonspecific anisopoikilocytosis and a mild monocytosis. The bone marrow biopsy…
