Expert Opinion :
This child is a case of Down’s syndrome. Since the child is only 2½ months on breast milk, nutritional anemia seems an unlikely cause of anemia and thrombocytopenia. Patients with Down’s syndrome are prone to myelodysplasia and leukemia. Hence the most likely cause would be a myelodysplastic disorder which presents in infancy, can lead to organomegaly and thrombocytopenia in addition to anemia. This child’s hemogram showed hemoglobin to 6 gm/dl, WBC count of 7,500/cumm, platelet count of 55,000/cumm and reticulocyte count of 1.4%. Bone marrow aspiration and biopsy showed no blasts and was suggestive of myelodysplasia.