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BMJ Case Reports Jul 2020A 21-year-old man presented to the emergency department with generalised weakness, weight loss and decreased appetite for few weeks. He had evidence of severe...
A 21-year-old man presented to the emergency department with generalised weakness, weight loss and decreased appetite for few weeks. He had evidence of severe pancytopenia and haemolysis. His peripheral smear with many schistocytes was suspicious for thrombotic thrombocytopenic purpura (TTP). He was supported with blood transfusions and daily plasmapheresis. His platelet counts worsened despite 4 days of therapy. Bone marrow biopsy was significant for hypercellular bone marrow with megaloblastic changes. Further workup revealed normal ADAMTS13 level, low vitamin B, positive intrinsic factor antibodies and high methylmalonic acid. Diagnosis of pernicious anaemia was established and he was started on daily treatment with intramuscular vitamin B which subsequently improved his symptoms and haematological parameters. This report highlights the importance of checking vitamin B level in patients presenting with pancytopenia and TTP-like picture before making a diagnosis of TTP.
Topics: Anemia, Pernicious; Humans; Male; Pancytopenia; Purpura, Thrombotic Thrombocytopenic; Young Adult
PubMed: 32624489
DOI: 10.1136/bcr-2020-235288 -
Journal of Medical Case Reports Aug 2023Nitrous oxide is a medical and household gas that has seen its use drift to recreational purpose among the young population in recent years. Significant neurological,...
BACKGROUND
Nitrous oxide is a medical and household gas that has seen its use drift to recreational purpose among the young population in recent years. Significant neurological, hematological and psychiatric side effects, generally related to an induced functional vitamin B12 deficiency, have been described separately in the literature.
CASE REPORT
A 22-year-old woman of North African origin experienced an exceptional combination of polyneuropathy, bilateral pulmonary embolism and severe pancytopenia related to vitamin B12 deficiency and hyperhomocysteinemia induced by recreational nitrous oxide use. After treatment with vitamin B12 supplementation and intensive rehabilitative management, the patient progressively regained the ability to walk and her biological parameters gradually returned to normal. The pathophysiological mechanisms related to a decrease in vitamin B12 activity are the reduction of products needed for synthesis of deoxyribonucleic acid, carbohydrate or fatty acids, and the increase of hyperhomocysteinemia. Other mechanisms involving a direct action of N2O are also suspected.
CONCLUSION
This case report brings elements to support our knowledge about pathological pathway, recovery and prognosis of recreational N2O abuse complications. The general and medical population should be aware to the serious consequences of this type of consumption.
Topics: Female; Humans; Young Adult; Adult; Pancytopenia; Hyperhomocysteinemia; Nitrous Oxide; Polyneuropathies; Pulmonary Embolism
PubMed: 37587485
DOI: 10.1186/s13256-023-04075-w -
The Primary Care Companion For CNS... Dec 2021
Topics: Humans; Intellectual Disability; Pancytopenia; Phenytoin; Sclerosis; Temporal Lobe; Valproic Acid; Young Adult
PubMed: 34942064
DOI: 10.4088/PCC.20cr02897 -
The Pan African Medical Journal 2019The aim of this study was to evaluate the severity of hematological findings according to etiology in patients with pancytopenia and bicytopenia.
INTRODUCTION
The aim of this study was to evaluate the severity of hematological findings according to etiology in patients with pancytopenia and bicytopenia.
METHODS
Patients with bicytopenia and pancytopenia who were examined in Diyarbakir Children Hospital Pediatric Hematology and Oncology clinic between June 2017-June 2018 were evaluated retrospectively.
RESULTS
Of the 130 patients included in the study, 73 (56.2%) were male and 43 (43.8%) were female. The mean age of the patients was 4.9 ± 4.86. Forty-five (34.6%) patients had pancytopenia and 85 (65.3%) had bicytopenia. The youngest patient was 1-month old and the oldest patient was 18-year-old. The mean blood count parameters were white blood cell (WBC): 10.207 ± 39.781, neutrophil: 1515 ± 1418, hgb: 9.3 ± 2.3, mean corpuscular volume (MCV): 80 ± 13.1, platelet: 118.823 ± 93.645. Three out of 130 patients had hyperleukocytosis (WBC > 50.000/mm). Vitamin B12 deficiency was detected in 35 patients. When patients with primary hematological disease were compared with patients with secondary causes of cytopenias, a significant difference was found in terms of leukocyte count, hemoglobin level, MCV elevation, and low platelet count.
CONCLUSION
The determination of the severity of cytopenias in differential diagnosis may be useful in distinguishing primary hematological diseases from secondary causes of pancytopenia and bicytopenia. However, vitamin B12 deficiency in developing countries is one of the most important causes of public health as well as in the etiology of pancytopenia and bicytopenia.
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Erythrocyte Indices; Female; Hematologic Diseases; Humans; Infant; Leukocyte Count; Male; Neutrophils; Pancytopenia; Platelet Count; Retrospective Studies; Severity of Illness Index; Vitamin B 12 Deficiency
PubMed: 32110266
DOI: 10.11604/pamj.2019.34.149.18749 -
Blood Jul 2012
Topics: Adult; Bone Marrow; Crystallization; Female; Humans; Hyperoxaluria, Primary; Oxalates; Pancytopenia
PubMed: 22953330
DOI: 10.1182/blood-2011-12-400192 -
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 -
The Canadian Veterinary Journal = La... Dec 2021A 4-year-old neutered male St. Bernard-mastiff crossbred dog showed clinical signs of lethargy and anorexia after being administered phenobarbital for the treatment of...
A 4-year-old neutered male St. Bernard-mastiff crossbred dog showed clinical signs of lethargy and anorexia after being administered phenobarbital for the treatment of idiosyncratic seizures. A complete blood (cell) count revealed pancytopenia. Auto-agglutination and Coombs tests were negative suggesting that an immunemediated cause was unlikely; therefore, an idiosyncratic reaction to phenobarbital was suspected. Supportive care and control of seizures with zonisamide was initiated and clinical signs improved. Blood values were monitored closely and returned to normal after 3 wk.
Topics: Animals; Dog Diseases; Dogs; Male; Pancytopenia; Phenobarbital; Seizures
PubMed: 34857972
DOI: No ID Found -
Blood Mar 2023Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT) that carries high mortality. Caused by immunocompetent donor...
Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT) that carries high mortality. Caused by immunocompetent donor leukocytes within the transplanted organ, which become activated against recipient tissues, GVHD typically develops 2 to 12 weeks after SOT and can affect the skin, gastrointestinal tract, liver, and bone marrow. Signs and symptoms are nonspecific and include a rash, nausea, appetite loss, diarrhea, and cytopenias. Pancytopenia from marrow-directed GVHD is the primary driver of mortality. The diagnosis of GVHD is often delayed but should be confirmed by biopsy of an affected organ. Evidence of donor chimerism in blood or marrow supports the diagnosis. When GVHD is diagnosed we initiate treatment with systemic corticosteroids. At that time, if GVHD only involves skin or oral mucosa we also decrease maintenance immunosuppression levels to allow the recipient to reject the donor immune cells. For GVHD involving the marrow we initiate an allogeneic hematopoietic cell donor search early. In this article, we describe 3 cases of GVHD after SOT, outline our approach to diagnosis and management, and then provide analysis of the 3 instructive cases.
Topics: Humans; Graft vs Host Disease; Organ Transplantation; Bone Marrow; Pancytopenia; Adrenal Cortex Hormones; Bone Marrow Transplantation
PubMed: 36395067
DOI: 10.1182/blood.2022015954 -
BMJ Case Reports Oct 2010Folate-deficiency anaemia occurs in about 4 per 100 000 people, although severe cases causing moderate pancytopenia are rarer. We present the case of a significant...
Folate-deficiency anaemia occurs in about 4 per 100 000 people, although severe cases causing moderate pancytopenia are rarer. We present the case of a significant folate deficiency in a 50-year-old alcoholic with a background of mild liver impairment and recurrent nasal and rectal bleeding. Her blood tests showed profound macrocytic anaemia with haemoglobin 2.6 g/dl, leucopoenia with white cell count 3.2 × 10(9)/litre and thrombocytopenia with platelets 17 × 10(9)/litre. Serum folate was 0.8 ng/ml (normal 2.5-13.5 ng/ml) confirming severe deficiency. Despite these life-threatening results, the patient was stable, alert and was keen to avoid admission. Medical management of the anaemia included slow transfusion of red cells and one unit of platelets in view of haemorrhagic symptoms, two injections of vitamin B12 while awaiting assays and oral folic acid. A rapid improvement in the leucopoenia and thrombocytopenia resulted and no additional complications were encountered.
Topics: Anemia, Macrocytic; Combined Modality Therapy; Epistaxis; Erythrocyte Transfusion; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Leukopenia; Liver Diseases, Alcoholic; Middle Aged; Pancytopenia; Platelet Transfusion; Thrombocytopenia; Vitamin B 12
PubMed: 22791479
DOI: 10.1136/bcr.03.2010.2851 -
Hematology. American Society of... Dec 2021Rapid advances in sequencing technology have led to the identification of somatic mutations that predispose a significant subset of the aging population to myeloid... (Review)
Review
Rapid advances in sequencing technology have led to the identification of somatic mutations that predispose a significant subset of the aging population to myeloid malignancies. Recently recognized myeloid precursor conditions include clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of unknown significance (CCUS). These conditions can present diagnostic challenges and produce unwarranted anxiety in some instances. While the risk of progression to myeloid malignancies is very low in CHIP, true CCUS confers an exponential increase in risk. Idiopathic cytopenia of unknown significance (IDUS) lacks the predisposing genetic mutations and has a variable course. In this review we define the early myeloid precursor conditions and their risk of progression. We present our diagnostic approach to patients with unexplained cytopenias and discuss the clinical consequences of CHIP and CCUS.
Topics: Aged, 80 and over; Clonal Hematopoiesis; Disease Management; Hematopoiesis; High-Throughput Nucleotide Sequencing; Humans; Male; Mutation; Pancytopenia
PubMed: 34889436
DOI: 10.1182/hematology.2021000272