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Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report

Overview of attention for article published in BMC Psychiatry, May 2018
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Title
Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
Published in
BMC Psychiatry, May 2018
DOI 10.1186/s12888-018-1743-6
Pubmed ID
Authors

Masahiro Takeshima, Hiroyasu Ishikawa, Akihiro Kitadate, Ryo Sasaki, Takahiro Kobayashi, Hiroshi Nanjyo, Takashi Kanbayashi, Tetsuo Shimizu

Abstract

Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia from other types of pancytopenia, especially idiopathic aplastic anemia (IAA), has not been studied. We encountered a case of pancytopenia in a patient with AN and relatively poor nutritional status, whose hematological findings mimicked those of IAA, specifically fatty bone marrow and absence of GMT. The patient was a 32-year-old woman with poorly controlled AN. At 31 years of age, her body mass index (BMI) had fallen from 17.0 kg/m2 to below 13.8 kg/m2. The patient presented with ongoing fatigue and thus was examined by a hematologist. Hematological findings were consistent with IAA: peripheral blood tests revealed pancytopenia, whereas the bone marrow displayed fatty replacement without GMT. Despite the absence of bone marrow features typically seen in malnutrition, the patient's hematological abnormalities had manifested after a decrease in body weight. Thus, although the bone marrow findings indicated IAA, we considered that the nutritional etiology of pancytopenia could not be thoroughly ruled out. Using nutritional therapy alone, the hematological abnormalities improved as BMI increased to 16.5 kg/m2. The final diagnosis was pancytopenia secondary to malnutrition because pancytopenia and fatty bone marrow improved after implementation of nutritional therapy alone. The present case is the first documented case of AN with pancytopenia for which bone marrow examination confirmed fatty marrow without any evidence of GMT. IAA and pancytopenia secondary to malnutrition can present the same clinical findings. This case is significant because it suggests a need to differentiate between malnutrition and IAA.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 32 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 32 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 4 13%
Student > Master 3 9%
Other 2 6%
Lecturer 2 6%
Professor 2 6%
Other 5 16%
Unknown 14 44%
Readers by discipline Count As %
Medicine and Dentistry 8 25%
Nursing and Health Professions 2 6%
Business, Management and Accounting 1 3%
Biochemistry, Genetics and Molecular Biology 1 3%
Unspecified 1 3%
Other 4 13%
Unknown 15 47%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 July 2019.
All research outputs
#15,523,867
of 23,072,295 outputs
Outputs from BMC Psychiatry
#3,443
of 4,763 outputs
Outputs of similar age
#210,451
of 330,746 outputs
Outputs of similar age from BMC Psychiatry
#114
of 127 outputs
Altmetric has tracked 23,072,295 research outputs across all sources so far. This one is in the 22nd percentile – i.e., 22% of other outputs scored the same or lower than it.
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