Oral low-dose tacrolimus therapy for refractory hemophagocytic syndrome associated with systemic lupus erythematosus

Etiological causes of pancytopenia: A report of 137 cases

OBJECTIVE

The aim of this study is to evaluate the etiological causes of pancytopenia in patients who were admitted to the hematology ward due to pancytopenia.

MATERIALS AND METHODS

All patients who were admitted to the hematology ward of Ministry of Health Istanbul Training and Research Hospital due to pancytopenia between 2013 and 2015 were retrospectively evaluated regarding etiological causes.

RESULTS

A total of 137 patients was evaluated. The etiological causes of pancytopenia were recorded as Vitamin B12 deficiency (n: 24; 17%), chronic liver disease (n: 21; 15%), malignancy (n: 19; 13%), myelodysplastic syndrome (n: 18; 13%), aplastic anemia (n: 11; 8%), rheumatic diseases (n: 7; 5%), and endocrine causes (n: 3; 2%).

CONCLUSION

The etiological causes of pancytopenia vary depends on patients' age, gender, country, and other conditions. Vitamin B12 deficiency is the most common treatable cause of pancytopenia. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imagings, without the need of a bone marrow examination.

An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome)

Context: Hemophagocytic syndrome (HPS) is mainly characterized by massive infiltration of bone marrow by activated macrophages and often presents with pancytopenia. Thrombotic microangiopathy (TMA) is also present with thrombocytopenia and renal involvement. Both conditions could coexist with each other and complicate the condition.

Evidence Acquisition: Directory of Open Access Journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science with keywords relevant to; Hemophagocytic syndrome, macrophage activation syndrome, interferon-gamma and thrombotic microangiopathy, have been searched.

Results: Viral infection, rheumatologic disease and malignancies are the main underlying causes for secondary HPS. calcineurin inhibitors and viral infections are also the main underlying causes of TMA in transplant recipients. In this review, we discussed a 39-year-old male who presented with pancytopenia and renal allograft dysfunction. With the diagnosis of HPS induced TMA his renal condition and pancytopenia improved after receiving intravenous immunoglobulin (IVIG) and plasmapheresis therapy.

Conclusions: HPS is an increasingly recognized disorder in the realm of different medical specialties. Renal involvement complicates the clinical picture of the disease, and this condition even is more complex in renal transplant recipients. We should consider the possibility of HPS in any renal transplant recipient with pancytopenia and allograft dysfunction. The combination of HPS with TMA future increases the complexity of the situation.