Aplastic anemia with platelet thrombi.

7’. K., a 67 year old white female, was admitted to the Albert Einstein Medical Center, Southern Division, on September 6, 1949, with the chief complaint of fever and soremness of the sisouthi and gums. She was ap )areIit1y well until two weeks before admissioni when she developed a cough, sore throat amid a mild coryza. Shse was treated at home with aspirin, phemsacetins, co(leimse, caffeine, sulfadiazine, amsd later wit Is pensicillims amid aureomycin without insproverisemst. Soreisess of the mouth developed onie week later, followed by enlargemerit arid tenderness of the gums. An infections of the right hand failed to respomid to local medications. hospitalizations was advised at this time. The I)aSt medical history and systemic review were essentially nsegative. There was nso history of exposure to ansv chemicals or solversts. Physical examinsat ions revealed a well develol)ed, whit e wonsan who appearetl acut clv ill. The blood pressure was 120/70, pulse 100, respirations 22 per niinute, teml)erature 102 F. The mucous membrarses of the mouth were reddened, the gums were inflamed and swollems and the few remaining teeth were carious. A few dried, brownish crusts were resent about the alae nasae. No pallor, scleral icterus, glossitis, purpura or hiepatosplenomegaly were nsoted. The reniairsder of the physical examiniat ion was nsornial except for a systolic apical niurmur. Laboratory tests ons the day of admission revealed the following: RBC 4.24 M. Hgb. 13.9 Gm. (89 per cemnt), I)latelets 110,000 per cu.mm., WBC 1200 with 100 per cent mature lymphocytes. Tue peril)hieral smear showed omnly slight ansisocytosis amid )0ikilocyto5i5. Hvpochromia was mimiimal. Sphserocytes ansd polychromatophilic macrocytes were isot seems. Urinsalysis (unscatheterized, (‘enstrifuged) showed a straw colored urine, specific gravity 1.018, no sugar or albumin, 8-10 WBC/HPF, 2-3 RBC/HPF. The 1)100(1 urea nitrogen was 12 mg. per cemst, blood sugar 102 mg. pee’ cent. A blood culture was negative. An x-ray of the chest was negative. A sternsal marrow aspirations performed on the tisird hospital day revealed a good lrepntrations of a markedly hypocellular marrow; megakaryocytes were present iii normal nunsbers arid platelet product ion appeared adequate. Erythropoiesis was norfliOh)lastic in nature but wnss virtually ahsenst. Gramsulopoiesis was markedly (Iiminiished with an apparent maturations arrest at (lie myelocyte ans(l metamyelocyte stage; only a rare band or segmented polvmorphoniuclear leukocvte was present. No foreign cells were seen. (Fig. 1.) This marrow was irsterpreted as illustrating a selective depression irs the number of