Age 33 Years, Pancytopenia
Contributed By: Dr. Imtenan Sharif
Nk Ali Bux, a 33 year old, soldier serving in Pakistan Army was referred to AFBMTC on 10th Sep, 2012 with pancytopenia. The patient gave history of gum bleeding off & on for last 2 years. Couple of weeks before admission he sustained injury while cutting wood and reported to CMH Sialkot. He was found to have pancytopenia; bone marrow examination was consistent with aplastic anemia. The patient was then shifted to our center for further workup and management.
Initial work up confirmed diagnosis of Aplastic Anemia. Cytogenetics showed normal karyotype. Flowcytometry revealed 2% red blood cells deficient in CD55 and CD59. The patient was 8/8 HLA matched with his younger brother. There were no comorbidities and HCT-CI score was zero.
The patient underwent allogeneic hematopoietic stem cell transplant on 7th Dec, 2012. Pre-transplant conditioning consisted of Flu120Cy160ATG20. Source of stem cells was combined bone marrow and PBSC harvest with a total cell dose of 6.1 x108/kg. Post-transplant period was uneventful and patient continued his immunosuppressive medications for a year which were then tapered off. STRs for donor chimerism remained more than 90% and lymphocyte subset analysis reported good immune reconstitution.
Nk Ali Bux is now off all medicines and has completed his vaccination. He is feeling fit and enjoying normal life. After transplant Ali Bux has been blessed with a daughter and a son in 2014 and 2015, respectively.