Thymectomy in Red Cell Aplasia - A Case Report

Abstract

1.1. Background: Pure Red Cell Aplasia (PRCA) is a very rare syndrome responsible for severe anemia due to absence or significant reduction of erythroid precursors in the bone marrow. It’s etiology is variable, ranging from a congenital disease to an acquired one. Secondary acquired PRCA may be associated with several conditions, including Thymic Tumors. 1.2. Case Presentation: A 42-year-old male presented to the Internal Medicine department with constitutional symptoms: non-intentional weight-loss, palpitations, somnolence. Clinical investigation showed a severe normocytic normochromic anemia, with significant reticulocytopenia. Due to clinical status, several blood transfusions were needed. Further investigation with bone marrow biopsy showed intact precursors for platelets and leukocytes, with absence of erythroid precursors; the primary diagnostic hypothesis was Pure Red Cell Aplasia, with no etiology well defined, however. In order to rule out other conditions, imaging scans were performed; the chest CT showed a large mediastinal expansive formation, compatible with Thymoma. Patient was submitted to Thymectomy by the Thoracic Surgery team, with posterior improvement of clinical and hemodynamic status. Even so, for definitive remission of the PRCA, a bone marrow transplant was needed. The patient was successfully treated and remains healthy so far.