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Key Features

  • Age: 6 months to 4 years

  • Normocytic anemia with reticulocytopenia

  • Absence of hepatosplenomegaly or lymphadenopathy

  • Erythroid precursors initially absent from bone marrow

Clinical Findings

  • Pallor is the most common sign

  • Hepatosplenomegaly and lymphadenopathy are absent


  • Anemia is normocytic

  • Peripheral blood smear shows no evidence of hemolysis

  • Platelet count is normal or elevated

  • Neutrophil count is normal or, in some cases, decreased

  • Early in the course, no reticulocytes are identified

  • The Coombs test is negative, and there is no evidence of chronic kidney disease, hypothyroidism, or other systemic disorder

  • Bone marrow examination shows severe erythroid hypoplasia initially; subsequently, erythroid hyperplasia develops along with reticulocytosis, and the anemia resolves


  • Some children require red cell transfusions if cardiovascular compromise is present

  • Resolution of the anemia is heralded by an increase in the reticulocyte count, which generally occurs within 4–8 weeks of diagnosis

  • Corticosteroids not needed because of short course

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