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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 -
Blood Nov 2012
Topics: Adult; Blood Cell Count; Bone Marrow; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Lymphoma, Large B-Cell, Diffuse; Pancytopenia
PubMed: 23289110
DOI: 10.1182/blood-2012-06-433003 -
Current Drug Safety 2024Toxicity associated with low doses of methotrexate (MTX) is low, but it may be fatal. Bone marrow suppression and mucositis are among the common side effects of low dose... (Review)
Review
Toxicity associated with low doses of methotrexate (MTX) is low, but it may be fatal. Bone marrow suppression and mucositis are among the common side effects of low dose MTX toxicity. Different risk factors have been reported for toxicities associated with low doses of MTX, including accidental use of higher doses, renal dysfunction, hypoalbuminemia, and polypharmacy. In this paper, we present a female patient who had mistakenly used 7.5 mg of MTX daily instead of the same dose of MTX on Thursday and Friday. She was presented with mucositis and diarrhea to the emergency department. Moreover, we searched the databases Scopus and PubMed for available studies and case reports on toxicities associated with MTX dosing errors. The most frequently observed toxicities included gastrointestinal lesions, nausea, vomiting, skin lesions, and bone marrow suppression. Leucovorin, hydration, and urine alkalinization were among the most frequently used treatments. Finally, we summarize the data on the toxicities of low doses of MTX in different diseases.
Topics: Female; Humans; Methotrexate; Pancytopenia; Mucositis; Arthritis, Rheumatoid; Leucovorin
PubMed: 37194235
DOI: 10.2174/1574886318666230516115737 -
BMJ Case Reports Sep 2020A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8...
A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×10/L and neutrophil count 0.22×10/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
Topics: Adult; Autoimmune Diseases; Female; Humans; Kidney Transplantation; Pancreas Transplantation; Pancytopenia; Postoperative Complications; Time Factors
PubMed: 32900732
DOI: 10.1136/bcr-2020-235851 -
JPMA. the Journal of the Pakistan... Jun 2022
Topics: Dengue; Humans; Pancytopenia; Physicians
PubMed: 35751352
DOI: 10.47391/JPMA.4941 -
Endocrine Practice : Official Journal... 2011To present a case of pancytopenia associated with hypopituitarism secondary to a macroprolactinoma. (Review)
Review
OBJECTIVE
To present a case of pancytopenia associated with hypopituitarism secondary to a macroprolactinoma.
METHODS
We report the clinical features on presentation and results of laboratory investigation. Findings on magnetic resonance imaging are illustrated. The response to hormone replacement therapy is summarized.
RESULTS
A 46-year-old man was referred with pancytopenia and secondary hypothyroidism. Laboratory investigation revealed hypopituitarism and a substantially increased prolactin level. Magnetic resonance imaging of the head demonstrated a macroprolactinoma. Hematologic investigation disclosed no other cause for the pancytopenia. Hormone replacement therapy was initiated with hydrocortisone, levothyroxine, and testosterone. Cabergoline was used to induce regression of the prolactinoma. A rapid improvement was seen in the cytopenias, with normalization of the blood cell counts after 8 months of treatment. This result has been sustained during 29 months of follow-up.
CONCLUSION
Pancytopenia associated with hypopituitarism has been reported in the literature as a rare occurrence limited to isolated case reports, predominantly associated with Sheehan syndrome. To our knowledge, this is the first reported case of pancytopenia associated with a macroprolactinoma. This finding is noteworthy because prolactin alone has been reported to support hematopoiesis in animal studies.
Topics: Humans; Hypopituitarism; Male; Middle Aged; Pancytopenia; Prolactinoma
PubMed: 21247847
DOI: 10.4158/EP10298.CR -
Blood Mar 2015
Topics: Amino Acid Metabolism, Inborn Errors; Bone Marrow Cells; Child, Preschool; Female; Hematopoietic Stem Cells; Humans; Pancytopenia
PubMed: 25927084
DOI: 10.1182/blood-2014-11-609479 -
Clinical Pediatrics Jul 2017
Topics: Blood Component Transfusion; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pancytopenia
PubMed: 27884942
DOI: 10.1177/0009922816678817 -
Human Pathology Jul 2014
Topics: Bone Marrow; Bone Marrow Examination; Female; Humans; Male; Pancytopenia
PubMed: 24796507
DOI: 10.1016/j.humpath.2013.10.041 -
Indian Journal of Dermatology,... 2023
Topics: Humans; Pancytopenia; Paraproteinemias
PubMed: 35146977
DOI: 10.25259/IJDVL_425_2021