On a warm October day in 2021, six-and-a-half-year-old Piper Law should have been basking in the ability to play outside, but she was not feeling like her usual perky self. Her mom, Amy, noticed her eye looked a bit red and there were numerous bruises on her legs. Since Amy was taking Piper’s older brother to see the family pediatrician, she thought it wouldn’t hurt if Piper went along, too.

When the family pediatrician saw Piper’s bruised legs, he ordered a complete blood count (CBC). When the results came back, he said: “I don’t want to alarm you, but her platelets are very low. You need to take her to the emergency room.”

A Family Connection

Those words are sure to scare most parents, but they were particularly terrifying for Piper’s parents. That’s because Piper’s aunt was diagnosed when she was a child with aplastic anemia, a rare life-threatening disease in which the bone marrow doesn’t make enough blood cells for the body.

At the time Piper’s aunt was diagnosed, 40 years ago, little was known about how to treat aplastic anemia. The experience shook Piper’s father, Justin, who was 8 at the time of his sister’s diagnosis. Naturally, when Piper’s parents got the news about their daughter’s extremely low CBC numbers, they were terrified at the possibility that their daughter would have to go through what her aunt had.

When Piper and her parents arrived at Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, they met with Katherine Armstrong, M.D., who specializes in childhood blood disorders. Dr. Armstrong ordered a bone marrow failure evaluation, which included a biopsy of Piper’s bone marrow. The results were stark. “Her bone marrow had failed, so Piper didn’t have enough red cells to carry oxygen, white cells to fight infection or platelets to stop excessive bleeding,” Dr. Armstrong says.

Not having enough red blood cells left Piper feeling weak and easily tired. To keep her stable, she had red blood cell transfusions every few weeks; to keep her from bleeding/bruising, she needed platelet transfusions every 4–5 days. Over the next several weeks, further testing found that Piper did indeed have aplastic anemia, but none of the tests could confirm that it was caused by genetics. 

“We don’t know exactly what triggered it,” says Dr. Armstrong. “We think it’s immune-mediated,” meaning Piper’s own immune system was attacking her bone marrow cells.

Blood Counts Back to Normal

Piper underwent immunosuppressive therapy, in which powerful drugs were used to “reset” her immune system. Unfortunately, this treatment didn’t work for Piper—not an uncommon situation, says Alfred Gillio, M.D., director of Hackensack’s Children’s Cancer Center and developer of the Bone Marrow Failure Program at the hospital. “About 65 percent of patients will respond to immunosuppressive therapy and not need a bone marrow transplant,” he says.

After finding a bone marrow match in Poland through an international bone marrow registry, Dr. Gillio performed the transplant in May 2022.

Because the drugs used in this treatment can impact fertility, Piper’s parents took advantage of a new fertility preservation program at the hospital. Through a minimally invasive procedure, one of Piper’s ovaries was removed and frozen so it will be available to her later if needed. “This may be a nonfactor,” says Amy, “but we wanted to give her every possibility and chance we could.”

While Piper’s hair fell out, she did so well overall that she was discharged early. Given the experience with his sister, Justin knew how traumatic his own daughter’s experience could have been. But it was nothing like that, he says.

“It was like a warm hug every time we went to the clinic,” he says. “That’s how it felt—like they got this.”

With her blood counts back to normal, Piper and her family are now waiting for her immune system to rebuild so she can resume more of her regular routines. There is only a very small chance of a recurrence, says Dr. Gillio.

Next Steps & Resources:

• Meet our sources: Katherine Armstrong, M.D., and Alfred Gillio, M.D.
• To make an appointment with Dr. Armstrong, Dr. Gillio or another pediatric oncologist near you, call 800-822-8905 or visit our website
• Joseph M. Sanzari Children’s Hospital is the only pediatric oncology program in New Jersey that can offer fertility preservation—including freezing an ovary and freezing testicular tissue—to all patients regardless of age or development. Learn more about our bone marrow transplantation program.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.