Case Archive
Hematology (Bone Marrow Transplants)
Ref. # 74518

A Pennsylvania man complained of fatigue to his family doctor for several years. His hemoglobin levels were often low. He presented to the ER after several weeks of increasing fatigue, malaise and the development of multiple petechiae and ecchymoses. Complete Blood Count (CBC) and bone marrow findings were consistent with a diagnosis of severe aplastic anemia. The patient was transferred to a major medical center for further evaluation and treatment. Primary treatment consisted of antithymocyte globulin in combination with cyclosporine A and corticosteroids. Family tissue typing indicated no suitable match. The patient was discharged and continued immunosuppressive treatment as an outpatient. Three months later the family was informed he had been entered in the bone marrow registry to look for an unrelated matched donor. The next month a second opinion confirmed the need for transplant evaluation. The next day the patient was admitted to the ER for neutropenic fever. Aggressive treatment consisted of antimicrobial therapy. He died of multisystem failure one month later. The attorney for the family noted that, apparently due to oversight or negligence, the patient was not in fact registered with national donor registries until three weeks before his death. A medQuest hematologist specializing in bone marrow transplants opined there was a negligent failure to search for an unrelated donor as soon as family members were found unsuitable. Indeed nothing would have precluded his consideration for a transplant up to the day before his demise. The patient's HLA-type was common therefore a suitable donor likely would have been found in a timely manner to permit him to undergo a transplantation. The delay in initiating the donor search adversely affected the chance for a cure. With durable correction of his hematologic disorder and sufficient recuperation period, the patient could have been able to return to work and enjoy a normal life expectancy.

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