A 15-year-old girl was admitted with a fifteen day history of high grade intermittent fever with chills along with passage of loose watery stools, 6-8 times/day, not containing any blood or mucus. On examination, she was thin lean girl, who was markedly pale but fully conscious and well oriented. Initial laboratory investigations were suggestive of pancytopenia with haemoglobin of 4.7 g/dl; white cell count 1.3x109/1 and a platelet count of 13x109/1. Mean corpuscular volume (MCV) was 99.3 fl, while peripheral blood film showed macrocytosis, anisocytosis and poikilocytosis. Erythrocyte sedimentation rate was 120 mm at the end of 1st hr and C-reactive proteins were elevated. Her ALT was raised to 70 U/L, bilirubin and alkaline phosphatase were with in normal limits. Serology for Hepatitis B and C was negative. Reticulocyte count was 1%. Her bone marrow aspiration and trephine biopsy showed hypercellularity with megaloblastic as well as dyserythroblastic cells suggesting a differential diagnosis of either myelodysplasia secondary to some infections or aplastic anemia in evolution. Injection Trividox B1, B6, and B12) and folic acid were also added to treatment because her serum B12 level was found to be at lower normal limit. Complete picture repeated 15 days showed a platelet count of 1610 x 109/L. This high countindicated reactive thrombocytosis confirming bone marrow recovery. The probable cause of this reactive thrombocytosis was recovery from acute infection or Vit B12 supplementation.
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