Severe anemia in childhood presenting as transient ischemic attacks.

Case Report This 2 year old girl was well until she awoke from a nap with left sided weakness. She was alert and aware of her deficit. Speech was not impaired. She was seen that afternoon by her pediatrician, but the hemiparesis (which lasted 15 minutes) had remitted by the time of examination. On the next day, she had a second 15 minute episode of left hemiparesis again following a nap. On the third day, she had another episode of left sided weakness and was hospitalized. Laboratory tests revealed severe normochromic, normocytic anemia (hemoglobin, 4 grams/dl; MCV, 82 FL; MCH, 29.7 PG; MCHC, 35.6%; reticulocyte count, 0.1%) while the white blood cell count, platelet count, and plasma glucose concentration were normal. She was transferred to The Milton S. Hershey Medical Center. The physical examination revealed an alert, but pale child; neurological examination was entirely normal. A bone marrow aspirate was hypocellular with virtual absence of red cell precursors. A diagnosis of transient erythroblastopenia of childhood was made on the basis of her age, normal hemoglobin F, and absence of erythro-