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Acquired disease is rare; in adults, it is usually idiopathic
Cases have been seen in association with systemic lupus erythematosus, chronic lymphocytic leukemia (CLL), lymphomas, or thymoma
Some medications (phenytoin, chloramphenicol) may cause red blood cell (RBC) aplasia
Rarely, anti-erythropoietin antibodies cause pure RBC aplasia in patients who are treated with recombinant erythropoietin
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The only signs are those of anemia unless the patient has an associated autoimmune or lymphoproliferative disorder
Transient episodes of RBC aplasia are probably common in response to viral infections, especially parvovirus infections
Acute episodes go unrecognized unless the patient has a chronic hemolytic disorder or a chronic immunocompromised state, in which case the hematocrit may fall precipitously
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Anemia is often severe and normochromic, with low or absent reticulocytes
RBC morphology is normal, and the myeloid and platelet lines are unaffected
Bone marrow
The bone marrow karyotype is normal on standard banding cytogenetics
Chest imaging may reveal a thymoma
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Possible offending drugs should be stopped
Most patients will require RBC transfusion support
Resection of thymoma alone may result in amelioration of anemia in a small percentage of cases
High-dose intravenous immune globulin has produced responses in a small number of cases, mainly during parvovirus infections
Treatment of choice for idiopathic cases is immunosuppressive therapy with a calcineurin inhibitor (ie, cyclosporine)
Monotherapy with corticosteroids produce responses in 30–60% of cases, but relapses are common once corticosteroids are discontinued
Anti-CD20 monoclonal antibody (rituximab) is the treatment of choice in the setting of anti-erythropoietin antibodies
In patients with an associated lymphoproliferative disorder, treating the neoplasm should also treat the anemia