Resolution Of Pancytopenia Research Articles

Successful Steroid Treatment of Pembrolizumab-induced Agranulocytosis That Developed after Splenectomy in a Patient with Non-small-cell Lung Cancer.

Neutropenia, a rare immune-related adverse event, affects patients receiving treatment with immune checkpoint inhibitors (ICIs). We herein report a case of pembrolizumab-induced agranulocytosis. An 83-year-old man was diagnosed with advanced-stage lung carcinoma concomitant with splenomegaly complicated by hypersplenism, causing pancytopenia. To avoid the risk of bone marrow suppression due to cytotoxic chemotherapy, pembrolizumab monotherapy was chosen. However, the patient developed agranulocytosis despite the resolution of pancytopenia through splenectomy performed after the fourth pembrolizumab cycle. Neutrophil counts improved after steroid treatment but not after granulocyte colony-stimulating factor treatment. This case demonstrated that neutropenia can sometimes develop abruptly after several ICI therapy cycles.

Outcome of dogs with bone marrow suppression secondary to Sertoli cell tumour.

Sertoli cell tumours are one of the most common canine testicular neoplasia. These tumours are significantly more likely to arise in cryptorchid dogs and are often functional, oestrogen-secreting tumours which can lead to fatal myelotoxicity. The goal of this study was to describe the outcome of dogs with oestrogen-induced bone marrow suppression secondary to Sertoli cell tumours in seven client-owned dogs. Medical records from April 1, 2011 through April 1, 2021 were reviewed to identify dogs that underwent surgical management of a Sertoli cell tumour with documented bone marrow suppression. Overall, 5/7 dogs required transfusion of blood products peri-operatively. Cases 1 and 6 received a transfusion of packed red blood cells (RBC) prior to surgery and case 5 required a transfusion of whole blood. Case 1 also required a transfusion of platelets before surgery. Post-operatively, cases 1 and 2 received packed RBC's and case 6 received two transfusions of whole blood. Case 3 required transfusions of both fresh frozen plasma and platelets post-operatively. All dogs survived to discharge and 6/7 dogs had documented improvement in haematopoietic values. Two dogs remained chronically thrombocytopenic. The median hospital stay was 4 days. One dog died within 4 weeks of surgery from worsening pancytopenia. Survival for greater than 1year was documented in 4/7 dogs, and one dog was lost to follow-up 4 months post-operatively. One dog remained severely pancytopenic 4 weeks post-operatively and received oral lithium treatment. Improvements in all blood cell lines were observed within the 4 weeks and resolution of pancytopenia within 6 weeks. Historically, the prognosis for dogs with bone marrow suppression secondary to Sertoli cell tumours was guarded to poor. This report documented improved outcomes for dogs that underwent surgery, including one dog that received lithium chloride as treatment for Sertoli cell tumour-induced bone marrow suppression.

Pancytopenia in a Patient With Severe Hypothyroidism: A Case Report

Abstract Introduction: Hypothyroidism usually affects red blood cell line most commonly seen as normochromic normocytic anemia. We present a unique case of a patient with pancytopenia in the setting of severe hypothyroidism, which improved following IV thyroid hormone replacement. Case: An 85-year-old female with history of type II diabetes mellitus and hypothyroidism who was admitted for open reduction and internal fixation (ORIF) of a displaced left femur fracture following a mechanical fall. Patient has a long-standing history of hypothyroidism on replacement with levothyroxine 75 mcg, which was inadvertently discontinued at the nursing home 2 weeks prior to presentation. CBC on admission was notable for pancytopenia with macrocytic anemia with hemoglobin of 6.2 g/dl (baseline of 11), leukopenia with WBC of 4.2 x103/ul and thrombocytopenia with platelet of 77 X 103 /ul. TSH was 83 uIU/mL (reference range: 0.34 - 5.6) and Free T4 was < 0.11 ng/dl (reference range: 0.93 - 1.7). Patient was on the verge of developing myxedema coma as she presented with hypotension with blood pressure of 103/55 mmHg, hyponatremia 133 mmol/L and mild change in mental status. There was no evidence for hypothermia or bradycardia. Presence of a small thigh hematoma on examination partially explained the acute drop in hemoglobin. Iron panel, folic acid and vitamin B12 levels were found to be within normal range. Patient had no active of infection to suggest sepsis and she did not receive any myelosuppressive medication. Rapid replacement with IV levothyroxine was started before proceeding with surgery to prevent development of myxedema coma. Free T4 normalized at 1.05 ng/dl after receiving a total of 700 mcg of IV levothyroxine on day 5 of hospitalization. ORIF was done with no complications. Pancytopenia resolved upon thyroid replacement therapy and she was discharged on her regular dose of levothyroxine 75 mcg daily. Discussion: Most common hematologic abnormality associated with hypothyroidism is normochromic normocytic anemia. Currently, there are less than 10 reported cases of pancytopenia associated with hypothyroidism. The exact mechanism is unclear but proposed hypothesis is transient bone marrow hypoplasia. The most common clinical presentation, as seen in our patient, is profound hypothyroidism with ultimate outcome of myxedema coma. Most of these patients had resolution of pancytopenia following adequate thyroid hormone replacement. Interestingly, all cases have been reported in female patient population. Further research is needed to understand pathophysiology, risk factors, prognosis and the risk of pancytopenia recurrence in patients with severe hypothyroidism. More importantly, hypothyroidism must certainly be entertained as a differential diagnosis of pancytopenia.

17213 Oral and skin ulceration in a patient with Alzheimer disease

Case Description: Case of a 76-year-old woman with history of hypertension, atrial fibrillation, arthritis of unknown origin, and Alzheimer disease who was evaluated for a 2-month history of painful oral mucosa erosions with hemorrhagic crusting accompanied with dysphagia. Lesions were treated unsuccessfully with oral antibiotics. Given no clinical improvement a bullous disease was suspected, and patient was started on prednisone. Laboratory results consisted of pancytopenia, hypoalbuminemia, and acute kidney injury. Tissue cultures were negative for bacteria, fungus, and atypical mycobacteria. Skin biopsy on the right lower abdomen showed ulceration with epidermal dysmaturation and dyskeratosis. Upon further questioning patient reported taking MTX 10 mg daily instead of weekly for her underlying arthritis. MTX was stopped and folic acid replacement was administered with resolution of pancytopenia and mucocutaneous lesions.

Vitamin B12 deficiency presenting as hemolytic anemia

Vitamin B12 deficiency is not an uncommon condition. Commonly patient presents with megaloblastic anemia and pancytopenia. There are reports in the literature of Vitamin B12 deficiency associated with other immunological conditions. We report such a case of Vitamin B12 deficiency associated with hemolytic anemia in a 36-year-old Indian man, who presented with pancytopenia and hemolytic anemia. Workup for other causes of hemolytic anemia was negative, and the patient responded to treatment with Vitamin B12, with resolution of pancytopenia and hemolysis. Clinicians need to be aware of this association as both conditions occur rarely together and unawareness may lead to unnecessary investigation and procedures.

Refractory Macrophage Activation Syndrome in a Patient with Systemic Lupus Erythematosus Treated with Tocilizumab

자가면역 질환에서 발생하는 대식세포 활성화 증후군(MAS)은 중증의 ì¹˜ëª ì ì¸ 합병증으로 ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤ì—ì„œ 드물게 발생한다. MAS에서 íŠ¹ì§•ì ìœ¼ë¡œ 보이는 발열, 혈구 감소는 ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤ì—ì„œë„ ë‚˜íƒ€ë‚ ìˆ˜ 있어 ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤ì— 동반된 MAS는 조기 진단이 ì–´ë µë‹¤. 따라서 ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤ 환자에서 ì ì ˆí•œ 치료에도 ë¶ˆêµ¬í•˜ê³ ë°œì—´ì´ 지속된다면 MAS를 감별진단으로 ê³ ë ¤í•´ì•¼ 한다. ì €ìžë“¤ì€ 발열을 주소로 내원한 40대 여자 환자를 ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤ì— 동반한 대식세포활성화 증후군으로 ì§„ë‹¨í•˜ê³ , ë©´ì—­ì–µì œ 치료 및 ì •ë§¥ìš© 면역글로불린, rituximab 치료에도 í˜¸ì „ë˜ì§€ 않아 tocilizumab을 사용 후 ì„±ê³µì ìœ¼ë¡œ 치료하였기에 ë¬¸í—Œê³ ì°°ê³¼ 함께 이를 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: 혈구포식 림프조직구증식증; 대식세포 활성화 증후군; ì „ì‹ í™ë°˜ë£¨í‘¸ìŠ¤

Autoimmune Myelofibrosis in Systemic Lupus Erythematosus Report of Two Cases and Review of the Literature.

Autoimmune myelofibrosis (AIMF) is a rare entity of steroid-responsive bone marrow fibrosis that accompanies a variety of autoimmune diseases, particularly systemic lupus erythematosus (SLE). Rarely it may occur in patients with autoimmune markers but no definable autoimmune disease (Primary-AIMF). We report the cases of two young women with SLE-associated AIMF (SLE-AIMF). The first patient was a young woman who had pancytopenia, massive splenomegaly and reticulin fibrosis in the marrow biopsy. The pancytopenia and splenomegaly resolved completely within weeks of treatment with corticosteroids. Repeat marrow biopsy showed marked regression of marrow fibrosis. The second patient was a young woman with fever, anasarca, bicytopenia and reticulin fibrosis in the marrow biopsy. Steroid therapy resulted in rapid clinical improvement and resolution of pancytopenia. A review of the literature revealed a total of 30 patients with SLE-AIMF reported to-date. Patients with SLE-AIMF are young women with SLE and blood cytopenia who are found to have increased bone marrow reticulin on marrow biopsy. Steroid therapy results in rapid hematological recovery and regression of marrow fibrosis. Whether AIMF is one of several hematological complications of SLE, or represents a unique and distinct subset of patients with SLE in not clear. Prospective studies with longer follow-up are needed to better define the prevalence and clinical spectrum of SLE-AIMF.

Spontaneous tumor lysis syndrome with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma unspecified

Tumor lysis syndrome is a well-described, serious complication of chemotherapy administered to treat malignancies. However, a very rare event resulting in the spontaneous necrosis of a tumor prior to therapy can also occur, which is termed spontaneous tumor lysis syndrome (STLS). We present a case of a 27-year-old male who presented to the hospital with epistaxis, dyspnea, and cervical lymphadenopathy. Laboratory findings included progressive pancytopenia, hyperuricemia, and acute renal failure. Bone marrow biopsy showed a T cell lymphoid neoplasm that had entirely infiltrated the marrow stroma. The patient was diagnosed with STLS in the setting of a T cell lymphoma with bone marrow infiltration. The patient was immediately treated with a blood transfusion and hemodialysis. After this urgent treatment, the patient's pancytopenia resolved and the lymphadenopathy disappeared spontaneously. One month post-treatment, the patient's cervical lymphadenopathy recurred and peripheral T cell lymphoma, not otherwise specified, was confirmed. STLS has previously been reported, however, most known cases of STLS did not show a decreased tumor burden resulting from massive tumor cell death. We present a rare case of STLS with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma not otherwise specified.

Immune Pancytopenia Associated with a Leukemic B-Cell Tumor Carrying t(14;18)(q32;q21) Translocation

We report a 75-year-old man who was initially suggested to have acute leukemia. The hemoglobin level was 3.8 g/dL, white cell count was 7,700/µL with an absence of mature neutrophils and 69.0% leukemic cells, and platelet was 0.4 × 10(4)/µL. Coombs' antiglobulin test was positive. Leukemic cells were CD5(-), CD10(+), CD20(+), CD23(-), and IgG/λ(dim+). The bone marrow consisted of normal hematopoietic precursors, whereas fluorescence in situ hybridization detected the BCL2/IgH fusion gene. He was treated with rituximab-containing chemotherapy, resulting in the resolution of pancytopenia. The underlying disease was a leukemic B-cell tumor with t(14;18)(q32;q21), and the pancytopenia was mainly caused by autoimmune mechanisms.