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International Journal of Rheumatic... Jul 2017Methotrexate (MTX) has the potential to cause serious adverse reactions and even mortality. We analyzed the predisposing factors and outcome in patients with MTX-induced...
AIM
Methotrexate (MTX) has the potential to cause serious adverse reactions and even mortality. We analyzed the predisposing factors and outcome in patients with MTX-induced pancytopenia admitted into our unit from 1996 to 2015.
METHODS
Patients were identified by departmental database search. Pancytopenia was defined as white blood cell count (WBC) < 3500 cells/mm , hemoglobin (Hb) < 11 g/dL and platelet count < 150 000 cells/mm . Severe pancytopenia was defined as WBC < 2000 cells/mm , Hb < 10 g/dL and platelet count < 50 000 cells/mm .
RESULTS
Forty-six patients were included in the study (female = 35). Twenty-four had been under the care of either primary care physicians or orthopedic surgeons and presented to us with pancytopenia. Sixteen patients had severe pancytopenia. Disease distribution was as follows: rheumatoid arthritis 33, psoriasis eight, systemic sclerosis two and others three. The median dose of MTX was 10 mg/week and median duration of treatment was 11 months. The median cumulative dose was 750 mg. Symptoms at presentation included: oral mucositis (n = 37); fever (n = 24); diarrhea (n = 12), bleeding gums (n = 5) and purpura (n = 3). The potential risk factors were: hypoalbuminemia (n = 23), renal insufficiency (n = 14), dosing errors (n = 13) and non-supplementation of folates (n = 7). Thirteen patients died. WBC at admission was found to determine survival (P < 0.05).
CONCLUSION
In patients on MTX, oral mucositis and fever can herald pancytopenia. MTX-induced pancytopenia is associated with high mortality. WBC at admission is the most important prognostic factor. There is need for increased awareness among physicians to minimize prescribing errors. A national guideline on monitoring of patients on MTX is desirable.
Topics: Adult; Antirheumatic Agents; Arthritis, Rheumatoid; Biomarkers; Databases, Factual; Female; Hemoglobins; Humans; Leukocyte Count; Male; Methotrexate; Middle Aged; Pancytopenia; Platelet Count; Psoriasis; Risk Factors; Scleroderma, Systemic
PubMed: 28261918
DOI: 10.1111/1756-185X.13004 -
Deutsche Medizinische Wochenschrift... Jan 2022The 79-year-old patient was admitted with recurring fever, weight loss, night sweat, a decrease in physical capacity and hematomas of the extremities.
HISTORY
The 79-year-old patient was admitted with recurring fever, weight loss, night sweat, a decrease in physical capacity and hematomas of the extremities.
FINDINGS
The patient presented with pancytopenia, elevated CRP and impaired renal function. A splenomegaly was evident in abdominal sonography. A bone marrow aspiration was performed.
DIAGNOSIS
Histopathologic examination revealed a visceral Leishmaniasis. The diagnosis was confirmed by PCR from peripheral blood.
THERAPY AND COURSE
After initiation of liposomal amphotericin B haematopoiesis recovered and CRP decreased. Initially the renal function deteriorated with prolongated improvement in the course of therapy.
CONCLUSIONS
Pancytopenia and corresponding symptoms are suspect for visceral Leishmaniasis also in patients supposed to be immunocompetent with travel history of endemic regions.
Topics: Aged; Antiprotozoal Agents; Diagnosis, Differential; Fever; Humans; Leishmaniasis, Visceral; Pancytopenia; Splenomegaly
PubMed: 35100643
DOI: 10.1055/a-1685-5173 -
Expert Review of Hematology Aug 2018Chronic lymphocytic leukemia (CLL) is frequently complicated by cytopenias, either due to bone marrow infiltration or autoimmunity, resulting in autoimmune hemolytic... (Review)
Review
Chronic lymphocytic leukemia (CLL) is frequently complicated by cytopenias, either due to bone marrow infiltration or autoimmunity, resulting in autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red cell aplasia (PRCA), or autoimmune neutropenia (AIN). Morbidity due to autoimmune cytopenias (AIC) can be substantial; in addition, infection risk increases and pre-existing infections might deteriorate due to immunosuppressive medication. In the aging population, CLL occurs more frequently and AIC related to CLL represent a growing clinical challenge. Areas covered: This review summarizes current knowledge on pathophysiological mechanisms involved in AIC development and their prognostic significance. It provides diagnostic criteria and a treatment guideline for daily clinical practice, which includes the role of novel targeted agents. Expert commentary: The pathophysiology of AIC involves loss of self-tolerance, antigen presentation by malignant CLL cells, and autoantibody production through aberrant T- and B-cell function. The value of detecting autoantibodies via the direct antiglobulin test (DAT) is disputable, since a positive test does not imply overt hemolysis. Importantly, AIC should be distinguished from infiltrative cytopenias, because of prognostic and therapeutic consequences. Compared to chemotherapy, triggering AIC by targeted therapies is less common and, hence, these agents may be valuable as treatment for CLL-related immune cytopenias.
Topics: Autoimmune Diseases; Biomarkers; Diagnosis, Differential; Disease Management; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Pancytopenia; Phenotype; Prognosis
PubMed: 29923432
DOI: 10.1080/17474086.2018.1489720 -
The American Journal of Medicine Jul 2023
Topics: Humans; Aged; Pancytopenia; Stomatitis; Methotrexate
PubMed: 36828213
DOI: 10.1016/j.amjmed.2023.01.047 -
The Veterinary Record Aug 2021
Topics: Animals; Cat Diseases; Cats; Pancytopenia
PubMed: 34415584
DOI: 10.1002/vetr.843 -
Deutsche Medizinische Wochenschrift... Oct 2016Telomere syndromes (syn. Telomeropathies) are inherited disorders hallmarked by accelerated telomere shortening based on a molecular defect within the... (Review)
Review
Telomere syndromes (syn. Telomeropathies) are inherited disorders hallmarked by accelerated telomere shortening based on a molecular defect within the telomerase/telomere complex. The rare, but well-defined model disorder Dyskeratosis congenita (DKC) characterized by typical skin manifestations and bone marrow failure represents the classical manifestation of telomere syndromes in childhood and adolescence. However, cryptic variants of DKC, clinically manifest through appearance of atypical bone marrow failure, lung fibrosis or liver cirrhosis - especially in adults up to the fifth decade of age - are frequently underdiagnosed. Clinical awareness is of utmost importance for this group of patients considering the fundamental implications of this diagnosis for treatment decisions and surveillance. Here, we review the importance of screening, correct diagnosis and therapeutic implications of telomeropathies in adult patients with mostly cryptic DKC with particular focus on (pan-)cytopenia as first and most frequent clinical manifestation.
Topics: Adult; Disease Progression; Dyskeratosis Congenita; Female; Humans; Male; Pancytopenia; Symptom Assessment; Treatment Outcome
PubMed: 27750347
DOI: 10.1055/s-0042-114869 -
Indian Journal of Medical Microbiology Jan 2021A 31 years old male presented with fever, dry cough, weight loss. Patient was found to be HIV positive and was started on empirical Anti-tubercular drugs (ATT). However,...
A 31 years old male presented with fever, dry cough, weight loss. Patient was found to be HIV positive and was started on empirical Anti-tubercular drugs (ATT). However, his symptoms persisted and he developed pancytopenia along with jaundice, and was shifted to our health care facility for further investigations. The patient has a history of travel to Bali and Thailand a few months ago. Patient was examined and relevant investigations were performed.
Topics: Adult; Diagnosis, Differential; Fever; HIV Infections; Humans; Male; Pancytopenia; Travel
PubMed: 33610248
DOI: 10.1016/j.ijmmb.2020.12.005 -
JPMA. the Journal of the Pakistan... Sep 2022To determine the aetiologies of pancytopenia based on bone trephine biopsy among paediatric and adult patients.
OBJECTIVE
To determine the aetiologies of pancytopenia based on bone trephine biopsy among paediatric and adult patients.
METHOD
The retrospective cross-sectional study was conducted at the Haematology Department of Aga Khan University Hospital, Karachi, and comprised data from June 1, 2016, to October 31, 2019 related to pancytopenia patients who underwent bone marrow biopsy. Data included age, gender, presenting symptoms, physical examination, complete blood count, peripheral smear, bone marrow aspirate and trephine biopsy findings and final diagnosis. Data was analysed using SPSS 19.
RESULTS
Of the 2852bone marrow biopsies done, 255(9%) related to evaluation of pancytopenia. Of them, 208(82%) were adult and 47(18%) were paediatric patients. The median age for adults was 38.8 years (range: 16-92years) and that in paediatric patients was 10.9 years (range: 2-15 years). Presenting symptoms were available for 182(71.4%) patients, and the commonest symptom was generalised weakness 128(70.3%). Overall, pallor was the most frequent sign 233(93.2%). Anisocytosis was predominant blood smear finding 156(61.1%), while the commonest aetiology was aplastic anaemia in both paediatric 23(49%) and adult 57(27.4%) groups. Bone marrow biopsy established the diagnosis in 253(99.2%) cases, while 2(0.95%) adult cases were not diagnosed. Of the diagnosed cases, 103(40.4%) were malignant; 15(32%) paediatric patients and 88(42.3%) adults. The rest were benign; 31(67.4%) paediatric patients and 119(3%) adults.
CONCLUSIONS
Bone marrow biopsy helped in diagnosing all but 2 pancytopenic patients. Aplastic anaemia was the commonest cause in both paediatric and adult patients.
Topics: Adult; Child; Humans; Adolescent; Young Adult; Middle Aged; Aged; Aged, 80 and over; Pancytopenia; Bone Marrow; Bone Marrow Examination; Anemia, Aplastic; Retrospective Studies; Cross-Sectional Studies; Biopsy
PubMed: 36280982
DOI: 10.47391/JPMA.2092 -
Clinical Laboratory Dec 2019Parvoviruses are small DNA viruses causing erythema infectiosum, which is known as the fifth disease. The aim of this study was to investigate the presence of Parvovirus...
BACKGROUND
Parvoviruses are small DNA viruses causing erythema infectiosum, which is known as the fifth disease. The aim of this study was to investigate the presence of Parvovirus B19 DNA by Real-Time-PCR retrospectively in clinical samples of children diagnosed as acute leukemia and aplastic anemia when investigating the cause of pancytopenia and to investigate its relationship with the clinical manifestations.
METHODS
The study samples were collected between March 2014 and March 2018 in Gazi University, Faculty of Medicine, Department of Pediatric Hematology. Sixty pediatric patients; 37 males and 23 females, were included in the study. Nucleic acid isolation was performed by using MagNA-Pure Compact Nucleic Acid Isolation Kit (Roche, Germany). Extracted DNA was studied with LightCycler® 2.0 using the Real-Time PCR method and LightCycler® Parvovirus B19 Quantification Kit (Roche, Germany), and the results were evaluated quantitatively. Parvovirus B19 DNA detection interval of the kit was 101 - 106 copies/mL.
RESULTS
Sixty serum samples were investigated and 8.3% (5/60) Parvovirus B19 DNA positivity was determined. Of the five patients with Parvovirus B19 DNA positivity, three had acute lymphoblastic leukemia and two were diagnosed as aplastic anemia. Regarding viral load; 2/5, 1/5, 1/5, and 1/5 of the samples had a viral load of 102, 103, 104, and 105 copies/mL, respectively. Parvovirus B19 DNA positivity was detected in samples from March (2/5), April (2/5), and August (1/5).
CONCLUSIONS
Patients with acute leukemia and aplastic anemia in childhood using immunosuppressive drugs, blood, and blood products during chemotherapy, encounter Parvovirus B19 infections in the follow-up period and are diagnosed by serological and molecular methods. As a result of the study, we suggest that the detection of Parvovirus B19 DNA by Real-Time PCR method in children being admitted with pancytopenia and diagnosed as acute leukemia and aplastic anemia is useful in the follow-up and treatment.
Topics: Adolescent; Anemia, Aplastic; Child; Child, Preschool; DNA, Viral; Erythema Infectiosum; Female; Humans; Immunosuppressive Agents; Infant; Male; Pancytopenia; Parvovirus B19, Human; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Real-Time Polymerase Chain Reaction; Retrospective Studies
PubMed: 31850715
DOI: 10.7754/Clin.Lab.2019.190311 -
Current Oncology Reports Aug 2019Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of immune-mediated cytopenias (IMC) after hematopoietic cell transplantation (HCT). (Review)
Review
PURPOSE OF REVIEW
Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of immune-mediated cytopenias (IMC) after hematopoietic cell transplantation (HCT).
RECENT FINDINGS
Key risk factors for post-HCT IMC include younger age, non-malignant disease, and umbilical cord blood stem cell source. While anemia predominates, any or all three hematopoietic cell lines can be affected. In rare cases, IMC can cause graft failure or death. IMC is hypothesized to result from immune dysregulation upon reconstitution of donor hematopoietic cells (i.e., dysfunctional regulatory T cells). Aside from blood product transfusions, IMC treatment includes immune-suppressive or ablative agents. First-line therapies, including corticosteroids and intravenous immunoglobulin, are often inadequate, prompting use of additional agents aimed at antibody production/T cell dysfunction or direct antibody removal via plasmapheresis. IMC occurs in up to 20% of high-risk HCT populations. Morbidity and mortality from IMC post-HCT have been reduced by improved recognition and aggressive early interventions.
Topics: Anemia, Hemolytic, Autoimmune; Graft vs Host Disease; Hematologic Diseases; Hematopoietic Stem Cell Transplantation; Humans; Pancytopenia; Prognosis; Thrombocytopenia
PubMed: 31414187
DOI: 10.1007/s11912-019-0838-7