Moderate AA is defined as having a hypocellular bone marrow and cytopenia in at least two cell lines not in the severe range. Clinical Findings Onset is insidious and the initial complaint may be progressive fatigue and weakness due to the anemia, followed in some cases by hemorrhage, usually from the skin and mucosal linings, due to thrombocytopenia. Although bleeding is usually mild, retinal or other CNS bleeds may occur as the presenting sign.
Infection is rare despite the severe neutropenia.
Physical examination reveals pallor and possibly bruising or petechiae , although these are not as evident as would be expected with the degree of thrombocytopenia. AA patients exhibit no lymphadenopathy or splenomegaly. Fever may or may not be present. RBCs may be mildly macrocytic due to increased erythropoietic stress but usually are normocytic and normochromic . The corrected reticulocyte count is very low or zero, indicating lack of erythropoiesis.