Occasionally a patient will develop aplastic anemia during or following infectious mononucleosis (IM, Epstein-Barr virus, EBV).


More common hematologic complications associated with infectious mononucleosis:

(1) immune-hemolytic anemia (with anti-i, anti-I, anti-N or other specificities)

(2) immune thrombocytopenia

(3) immune neutropenia


Risk factors for aplastic anemia:

(1) immunosuppression (autologous bone marrow transplant, other)

(2) immunodeficiency (X-linked lymphoproliferative disorder, other)


Clinical and laboratory features:

(1) The patient has or recently had evidence of acute infectious mononucleosis (pharyngitis, fatigue, cervical lymphadenopathy).

(2) The patient has IgM antibodies to EBV.

(3) Pancytopenia develops, with decreased bone marrow cellularity affecting the erythroid, myeloid and megakaryocytic series.

(4) Acute infection may develop associated with absolute neutropenia.

(5) Bleeding may develop, associated with thrombocytopenia (petechiae, purpura, epistaxis, etc)

(6) There is molecular evidence of EBV in bone marrow tissue.


Failure to recognize (false negative):

(1) failure to test for EBV-related antibodies

(2) subclinical mononucleosis


Differential diagnosis:

(1) drug-induced aplastic anemia

(2) aplastic anemia associated with viral hepatitis or other viral infections

(3) hemophagocytic syndrome (which may arise out of EBV infection)


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