Imaging Diagnosis of Neonatal Anemia: Report of Two Unusual Etiologies
A 3-month-old male child presented with history of pallor, abdominal distension, petechial rashes, recurrent respiratory infections, and repeated hospitalization since birth. Records of the previous hospitalization revealed persistent anemia and thrombocytopenia. Routine hemogram at our hospital revealed anemia (Hb 6.3 g/dl), leukocytosis (total leukocyte count (TLC)-83,000 cells/mm3), and thrombocytopenia (platelet count-35,000 cells/mm3). Skeletal survey (X-ray) requisitioned to rule out congenital infections revealed diffuse osteopenia and prominent calcific zone at metaphyseal ends of the long bones []. Radiograph of the dorsolumbar spine showed osteopenia with prominent vertebral end plates []. Abdominal sonography revealed hepatomegaly and increased hepatic echogenicity []. The infant showed no facial dysmorphisms suggestive of chromosomal disorder and karyotyping was negative for chromosomal anomalies. The serum biochemical parameters including the liver and renal function tests were within normal limits. The TORCH serology test for toxoplasmosis, rubella, cytomegalovirus, and herpes virus that includes enzyme-linked immunosorbent assay for detection of immunoglobulin IgG antibodies was found to be negative. The radiological and sonographic abnormalities seen in an anemic neonate with negative TORCH serology, and normal serum biochemical parameters suggested leukemic infiltration. Magnetic resonance imaging (MRI) of the lumbosacral spine and pelvis, revealed abnormal marrow signal intensities in bilateral iliac bones []. Bone marrow biopsy from the iliac bones revealed marrow infiltration with immature lymphoblasts and diagnosis of acute lymphoblastic leukemia was confirmed []. The infant was started on induction chemotherapy and is on regular follow-up.