Acquired aplastic anemia: Is bystander insult to autologous hematopoiesis driven by immune surveillance against malignant cells?

Table 1 Major laboratory results for the investigation of this patient

Specific results
Complete blood count
WBC, 2600/µL; ANC, 980/µL; RBC, 2560000/µL; Hb, 5.9 g/dL; Plt, 7000 /µL; Ret, 137600/µL, CRP, 62.42 mg/L
Coagulation profile
APTT, 38.4 s; PT, 12.6 s; TT, 17.7 s; Fig, 2.56 g/L; DD 0.69 mg/L
Abnormalities in biochemical tests
Elevated serum levels of: Uric acid, 8.52 mg/dL; Urea nitrogen, 26.04 mg/dL; Glucose, 418.68 mg/dL; Potassium, 23.44 mg/dL; β2-microglobulin, 4.58 mg/L; Reduced serum levels of: Albumin, 33.1g/L; Globulin, 18.1 g/L; Sodium, 3.10 mg/dL; Calcium, 8.24 mg/dL; Carbon dioxide, 19.3 mmol/L
Complements
C3, 0.62 g/L; C4, 0.11 g/L
Germicultures of the blood
Positive result for Candida albicans; Negative results for aerobic and anaerobic bacteria
Morphological evaluation of the BM and PB smears
BM: Promyelocytes, 0.5%; Myelocytes, 1.5%; Metagranulocytes, 2.5%; Stab cells, 3.0%; Segmented granulocytes, 1.5%; Eosinophilic granulocytes, 0.5%; Early erythroblasts, 3.5%; Intermediate erythroblasts, 15.0%; Late erythroblasts, 62.0%; Lymphocytes, 9.5%; Monocytes, 0.5%; PB: Metagranulocytes, 4.0%; Stab cells 18.0%; Segmented granulocytes, 7.0%; Early erythroblasts, 2%; Intermediate erythroblasts, 11%; Late erythroblasts, 49%; Lymphocytes, 9.0%
Flow cytometric analysis for the BM specimen
CD45-, 48.30%; CD45-CD71+, 35.68%; CD34, 2.16%; CD117, 6.86%; HLA-DR, 16.74%; CD34+CD117+, 1.59%; CD34+HLA-DR+, 1.06%; CD13, 39.42%; CD33, 36.4%; CD11b, 40.57%; CD16, 24.96%; CD14, 5.52%, CD64, 23.22%; CD13+CD16+, 24.34%; CD15+CD11b+, 29.38%; CD3, 11.71%; CD2, 7.39%; CD4, 9.72%; CD8, 15.78%; CD5, 5.36%; CD7, 5.25%; CD56, 10.63%; CD3+CD2+, 5.57%; CD3+CD4+, 4.57%; CD3+CD8+, 6.97%; CD3+CD5+, 5.24%; CD3+CD56+,1.02%; CD3+CD7+, 4.22%; CD19, 2.19%; CD19+CD20+, 1.57%; CD19+CD10+, 0.14%; CD19+CD5+, 0.12%; CD19+CD38+, 0.13%
PHN clone analysis
Red blood cells: CD55, 99.69%; CD59, 99.51%; Granulocytes: CD55, 98.03%; CD59, 96.30%
Conventional cytogenetic analysis
45,XY,-7[10]
Genetic investigations for hematopoietic malignancy
Positive results for KRAS, 44.2%; RUNX1, 43.8%; PTPN11, 45.4%; SETBP1, 49.5%; Negative results for GNAS, NRAS, HRAS, ASXL1, EZH2, DNMT3A, TET2, SF3B1, SRSF2, U2AF1, ZRSR2, STAG2, CBL, CBLB, CBLC, CUX1, ETV6, GATA2, IDH1, IDH2, JAK2, MPL, CALR, NOTCH1, WT1, TP53

WBC: White blood cell count; Hb: Hemoglobulin level; Plt: Platelet count; BM: Bone marrow; PB: Periphery blood.