Pure Red Cell Aplasia in a Tropical Setting: A Comprehensive Etiological Profiling of the Largest Cohort from South Asia.
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UNLABELLED: Pure red cell aplasia (PRCA) is a rare hematological disorder with diverse etiologies and variable regional prevalence. Data from tropical, resource-limited settings are sparse. This study presents the largest single-center PRCA cohort from South Asia, aiming to delineate the etiological spectrum, clinical features, and diagnostic challenges in this unique population. A retrospective analysis was conducted on 116 PRCA patients diagnosed between March 2017 and March 2025 at a tertiary care center in South Asia. Etiological classification was based on clinical, laboratory, and bone marrow findings, with supplementary molecular and serological testing where available. Demographic, clinical, and laboratory data were analyzed to identify correlations with PRCA subtypes. Secondary PRCA accounted for 74% of cases, with parvovirus B19 infection being the most common etiology (31% isolated, 14% overlap syndromes). Idiopathic/autoimmune PRCA constituted 19%, while drug-induced cases accounted for 6.9% and malignancy-associated PRCA 8.6%. Thymoma-associated PRCA was rare (1.7%). Pediatric cases (28.5%) exhibited higher rates of parvovirus and idiopathic PRCA. One case of congenital PRCA, diagnostic of Diamond-Blackfan anemia, was reported.The etiological profile of PRCA in tropical South Asia is distinct, dominated by infectious and idiopathic causes. A tiered, resource-sensitive diagnostic approach is essential. Bone marrow morphology, especially identification of giant pronormoblasts, contributed significantly for the diagnosis in resource-constrained settings. Our findings emphasize the need for regionally tailored diagnostic and management strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s12288-025-02271-w.