case_images: PMC9894639_01
case_images: PMC9894639_02
case_images: Transformation of SAA to MDS.. (A) H&E 100x of bone marrow biopsy at the time of initial aplastic anemia diagnosis. Only scant marrow elements (5% cellularity) are present with no increase (1%) in CD34(+) blasts. (B) CD34 immunohistochemistry 200x. (C) H&E 100x of bone marrow biopsy 11 months later, showing a hypercellular bone marrow (70%-80% cellularity), erythroid hyperplasia, and increased (10%-12%) CD34(+) blasts. (D) CD34 immunohistochemistry 200x.. SAA, severe aplastic anemia; MDS, myelodysplastic syndrome; CD34, cluster of differentiation 34.
case_images: cureus-0015-00000033276-i01.jpg
case_images: PMC9894639_02_cureus-0015-00000033276-i01.jpg
case_images: FIG1
case_images: A subsequent third biopsy performed 4-5 months after the initial biopsies showed 5% cellularity with decreased trilineage hematopoiesis (Figure 1).
case_images: PMC9894639_03
case_images: Echocardiography of pericardial effusion.. (A) Parasternal short axis view of echocardiogram at the basal level of the left ventricle demonstrating an anterior/posterior view of the pericardial effusion (indicated by white arrow). (B) M-mode demonstrating diastolic collapse of the right ventricle (indicated by yellow shade) secondary to the pericardial effusion.
case_images: cureus-0015-00000033276-i02.jpg
case_images: PMC9894639_03_cureus-0015-00000033276-i02.jpg
case_images: FIG2
case_images: However, echocardiography 6.5 months after initial presentation showed an enlarged, basal, posterior effusion with signs of hemodynamic compromise, including right atrial systolic collapse, right ventricular diastolic collapse, and abnormal respiratory variation in early diastolic mitral and tricuspid inflow (Figure 2).
case_images: PMC9894639_04
case_images: PMC9894639_05
case_images: PMC9894639_06