Haematology: aplastic anaemia: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology: aplastic anaemia

Sample item

A 19-year-old man has three weeks of fever and bleeding gums. Haemoglobin is 6 g/dL, white cells 1,200 per microlitre with an absolute neutrophil count of 300, and platelets 12,000. There is no splenomegaly or lymphadenopathy, and the marrow is hypocellular with fat replacement and no abnormal cells. His HLA-matched sibling is willing to donate. What is the treatment of choice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Allogeneic haematopoietic stem cell transplantation from the matched sibling

Pancytopenia with a hypocellular fatty marrow and no infiltration or organomegaly is aplastic anaemia, here severe. In young patients with an HLA-matched sibling donor, stem cell transplantation offers cure and is the treatment of choice. Immunosuppression with ATG and ciclosporin is used for older patients or those without a donor.

Option by option

  • A. Allogeneic haematopoietic stem cell transplantation from the matched sibling (correct)

    Correct. Transplant replaces the failed marrow and offers long-term cure in a young patient.

  • B. Antithymocyte globulin with ciclosporin as first choice

    ATG with ciclosporin is the alternative when no matched donor exists or in older patients.

  • C. Repeated platelet transfusions and observation

    Supportive transfusion alone does not treat marrow failure and carries high mortality.

  • D. Long-term prednisolone alone

    Steroids do not restore marrow function in aplastic anaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Allogeneic haematopoietic stem cell transplantation from the matched sibling. Pancytopenia with a hypocellular fatty marrow and no infiltration or organomegaly is aplastic anaemia, here severe.

Why is "Antithymocyte globulin with ciclosporin as first choice" not the answer?

ATG with ciclosporin is the alternative when no matched donor exists or in older patients.

Why is "Repeated platelet transfusions and observation" not the answer?

Supportive transfusion alone does not treat marrow failure and carries high mortality.

Why is "Long-term prednisolone alone" not the answer?

Steroids do not restore marrow function in aplastic anaemia.

What concept does this question test?

It tests Haematology: aplastic anaemia in General Medicine. In young patients with an HLA-matched sibling donor, stem cell transplantation offers cure and is the treatment of choice. Immunosuppression with ATG and ciclosporin is used for older patients or those without a donor.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: aplastic anaemia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.