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

Figure 1 Computerized tomography examination of the abdomen. A and B: Computerized tomography examination of the upper abdomen reported an enlarged liver and an enlarged spleen; C and D: Computerized tomography examination of the intermediate and low abdomen displayed the increased fluids and multiple liquid gas interfaces in the intestinal lumen (marked by white arrows) as well as the thickened walls of terminal ileum, ascending, and sigmoid colon (marked by orange arrows), in accordance with the diagnosis of an adynamic ileus and colonitis that provides evidence for the presence of gut inflammatory disease.

Figure 2 Morphological examination of bone marrow and periphery blood smears. A: Morphological examination of bone marrow (BM) smears under low power lens (10 × 10) showed a normal cellularity, in the absence of fatty replacement; B: Morphological enumeration of BM nucleated cells under high power lens (10 × 100) showed an increased percentage of nucleated erythrocytes in multiple stages (marked by white arrows), with markedly reduced percentages of myeloid precursors and lymphocytes; C: Morphological examination of periphery blood (PB) smears under low power lens (10 × 10) showed an increase in nucleated cells, predominantly nucleated erythrocytes; D: Morphological enumeration of PB nucleated cells under high power lens (10 × 100) showed the presence of nucleated erythrocytes in multiple stages (marked by black arrows), with marked anisocytosis, acanthrocyte, and schistocyte in mature erythrocytes (marked by orange arrows). The morphological features of the BM and PB fulfilled the diagnosis of an erythroid proliferative disease and the toxic damage of erythrocytes.