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Pathology · Haematology: Fanconi anaemia
Sample itemA 7-year-old boy has short stature, café-au-lait macules, absent thumbs and progressive pancytopenia. Which investigation is most likely to confirm the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Chromosomal breakage test with diepoxybutane or mitomycin C
Fanconi anaemia is an inherited DNA interstrand cross-link repair disorder that causes bone marrow failure, congenital anomalies such as radial ray defects and a high risk of acute myeloid leukaemia and squamous cancers. Cells show increased chromosomal breaks after exposure to cross-linking agents like diepoxybutane or mitomycin C. Haematopoietic stem cell transplantation is the curative treatment for marrow failure.
Option by option
A. Direct antiglobulin test
A direct antiglobulin test detects autoimmune haemolysis, and it is not the cause of marrow failure with limb defects.
B. Flow cytometry for CD55 and CD59
CD55 and CD59 flow cytometry diagnoses PNH, which does not cause congenital anomalies.
C. Osmotic fragility test
Osmotic fragility testing diagnoses hereditary spherocytosis, which is not a cause of pancytopenia.
D. Chromosomal breakage test with diepoxybutane or mitomycin C (correct)
Excess chromosome breakage with cross-linking agents is the diagnostic test.
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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