Non-hemolytic normocytic anemia Quiz: Ace Your Exams

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A 13-year-old girl comes to the pediatrics PA complaining of exertional dyspnea and easy bruising for the last 2 weeks. She had an upper respiratory infection 3 weeks ago. The remainder of the patient’s past medical history is non-contributory. Temperature is 37.2°C (98.9°F), pulse is 72/min, respirations are 14/min, and blood pressure is 116/68 mmHg. Physical exam shows conjunctival pallor, large purple contusions on the legs, and petechiae on the inside of the mouth. The abdominal exam shows a non-tender, non-distended abdomen and no hepatosplenomegaly. Laboratory testing is obtained and reveals the following:

 Laboratory value  Result  Reference Range 
 Hematologic  
 Hemoglobin  9.1 g/dL  12-16 g/dL 
 Mean corpuscular volume (MCV)   82 fL  80-100 fL 
 Reticulocyte index  1.6%  0.5-1.5% 
 Platelet count  80,000/mm3   150,000-400,000/mm3 
 Leukocyte count   3,000/μL  4,500-11,000/μL 

Which of the following would most likely be seen on microscopic examination of this patient’s bone marrow?

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