1
|
Darole P, Sundar U, Kuchekar N, Karre A. Unusual presentation of extramedullary haematopoiesis in a young boy. BMJ Case Rep 2019; 12:12/3/e227199. [PMID: 30904883 DOI: 10.1136/bcr-2018-227199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute transverse myelopathy in a young person may be due to infection, postinfective or inflammatory demyelination, or vascular causes. Rarely, a completely reversible cause of acute transverse myelopathy may be seen, as described here in our case of transverse myelopathy due to extramedullary haematopoiesis (EMH). An 18-year-old man who had a history of a lone blood transfusion at age of 7 years presented with paraplegia. MRI showed multiple epidural space masses of EMH compressing the spinal cord. He was detected to have thalassaemia intermedia and was treated with blood transfusions, steroids and radiotherapy to the involved paraspinal areas. He recovered fully over 15 days and remained symptom free at 6 months.
Collapse
Affiliation(s)
- Pramod Darole
- Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Uma Sundar
- Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Nilesh Kuchekar
- Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Ajay Karre
- Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| |
Collapse
|
2
|
La VT, Diatte M, Gaston J, Dick D, Sweiss R, Pakbaz Z. Spinal cord compression due to extramedullary hematopoiesis in a patient with E-beta-thalassemia managed without radiation or surgery. J Community Hosp Intern Med Perspect 2018; 8:246-249. [PMID: 30181838 PMCID: PMC6116288 DOI: 10.1080/20009666.2018.1490141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/12/2018] [Indexed: 11/07/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) in individuals with thalassemia is often the result of undertreated severe anemia. Radiation or surgery is often the chosen approach to handle spinal cord compression due to these paraspinal EMH elements. Our patient is a 28-year-old male with E-beta-thalassemia who presented with both upper thoracic and lower extremity symptoms of spinal cord compression and was successfully managed with the combination of transfusion and hydroxyurea. Given the variation in symptoms as a result of the sporadic location as well as the extent of these EMH elements along the spinal canal, the hematological communities will continue to benefit from case reports that offer treatment therapy.
Collapse
Affiliation(s)
- Van T La
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Michael Diatte
- Internal Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Johnathan Gaston
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Dallas Dick
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA.,Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Raed Sweiss
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Zahra Pakbaz
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA.,Internal Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, USA.,Hematology, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| |
Collapse
|
3
|
Garg K, Singh PK, Singh M, Chandra PS, Sharma BS. Long segment spinal epidural extramedullary hematopoiesis. Surg Neurol Int 2013; 4:161. [PMID: 24404404 PMCID: PMC3883269 DOI: 10.4103/2152-7806.123657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Extramedullary hematopoiesis is defined as the formation of blood cells outside the bone marrow. It is a common manifestation of many chronic hemolytic anemias, and typically involves the liver, spleen, and lymph nodes. Only rarely is the spinal epidural space involved. Methods: We describe a 25-year-old male, known to have thalassemia intermedia, who presented with a 1-month history of stiffness and weakness in both lower extremities. On physical examination, he had palpable splenomegaly accompanied by spinal tenderness at the D5 level, weakness in both lower extremities, hyperactive bilateral Patellar and Achilles reflexes with bilateral Babinski responses, and a graded sensory loss to pin appreciation below D5. Results: The magnetic resonance (MR) study revealed a posterior, isointense and soft tissue epidural mass extending from D2 to D12 on both the T1- and T2-weighted images. These findings were consistent with the diagnosis of “red marrow,” and long-segment spinal epidural extramedullary hematopoiesis. Conclusions: Although extramedullary hematopoiesis is rarely encountered within the spinal canal, it should be considered among the differential diagnoses when a posterior compressive thoracic lesion contributes to myelopathy in a patient with a history of thalassemia intermedia and the accompanying chronic hemolytic anemia.
Collapse
Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
4
|
Ghieda U, Elshimy M, El Beltagi AH. Progressive spinal cord compression due to epidural extramedullary hematopoiesis in thalassemia intermedia. A case report and literature review. Neuroradiol J 2013; 26:111-7. [PMID: 23859178 DOI: 10.1177/197140091302600119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/06/2013] [Indexed: 11/17/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) can occur in patients with thalassemia intermedia as a physiologic response to insufficient erythropoiesis to meet circulatory demands. Rarely, EMH involve the epidural space causing spinal cord compression. We describe a case of EMH in a 21-year-old man with β-thalassemia intermedia presenting with progressive low back pain, worsening paraparesis and sphincter disturbance. Magnetic resonance imaging (MRI) demonstrated spinal cord compression by EMH epidural mass lesions extending from T3 to T10 levels. An emergency multilevel decompressive laminectomy was performed with excision of the masses and complete rehabilitation of the patient.
Collapse
Affiliation(s)
- U Ghieda
- Radiology Department, MOH-Kuwait, Al-Amiri Hospital; Sulaibikhat, Kuwait.
| | | | | |
Collapse
|
5
|
Cho Y, Iizuka S, Hatae Y, Kobayashi K, Hattori Y, Yamashiro Y, Ariga T. A 25-year observation of a Japanese female patient with Hb Nottingham who has two children with the same disorder. Hemoglobin 2012; 36:446-55. [PMID: 22794346 DOI: 10.3109/03630269.2012.703980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We undertook a 25-year observation of a female patient with an unstable variant, Hb Nottingham or β98(FG5)Val→Gly, GTG>GGG. The proband was diagnosed with Hb Nottingham at the age of 9 years. Splenectomy was performed in order to successfully aid her height growth due to chronic anemia at the age of 11, although anemia improvement was transient. She experienced pregnancy/delivery twice, at age 23 and 26, respectively. During both pregnancies, a large number of nucleated red blood cells (NRBCs) appeared in her peripheral blood. No developmental delay of the fetus was noted in either pregnancy, and she gave birth without any maternal complications or perinatal problems. Both babies were diagnosed with Hb Nottingham. To the best of our knowledge, this is the first report of a long-term observation of a proband with Hb Nottingham, including her pregnancy/delivery and the neonatal course of her children with the same disorder.
Collapse
Affiliation(s)
- Yuko Cho
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
6
|
Varlet G, N'dri Oka D, Drogba KL, Haïdara A, Zunon-Kipré Y, Ba Zézé V. [Beta-thalassemia intermedia complicated by spinal cord compression. Report of three cases and meta-analysis]. Neurochirurgie 2010; 56:315-23. [PMID: 20417531 DOI: 10.1016/j.neuchi.2010.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
Extramedullary hematopoiesis is common in patients who suffer from beta-thalassemia. Extramedullary hematopoiesis is a compensatory mechanism of chronic anemia. Although the diagnosis is relatively easy, management is still the subject of considerable controversy. The aim of the present paper is to report three cases of spinal cord compression due to beta-thalassemia followed by a meta-analysis. In one of the three cases reported, spinal compression revealed beta-thalassemia. Forty-three cases have been reported in the last 10 years, i.e., four cases per year. The diagnosis was made by CT and myelography and confirmed by histology after surgical treatment. Two patients were followed in the hematology department. Young patients accounted for 95.45% of cases. The time to diagnosis was 3.33 months (3 days to 12 months). The most sensitive exam for diagnosis is magnetic resonance imaging before surgery. The MR image shows a hypointense lesion on T1-weighted sequences in 30.43% of cases or isointense on T2-weighted sequences in 34.78% of cases, and hypointense on T1-weighted sequences enhanced with gadolinium in 42.85% of cases. When MRI is absent, as in our patients, myelography can provide the diagnosis. The vertebrae are enlarged and translucent in 85.71% of cases with a hypodense lesion compressing the spinal cord. Laboratory tests show chronic microcytosis hemolytic anemia in 97.17% of cases. The diagnosis was established by histology performed after surgical removal. The patients recovered 97.5% of their neurologic deficiency after specific treatment. The mean follow-up was 2 years (4 weeks to 15 years).
Collapse
Affiliation(s)
- G Varlet
- Service de neurochirurgie, CHU de Yopougon, Abidjan, Cote d'Ivoire
| | | | | | | | | | | |
Collapse
|
7
|
Paraspinal extramedullary hematopoiesis in patients with thalassemia intermedia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:871-8. [PMID: 20204423 DOI: 10.1007/s00586-010-1357-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 02/04/2010] [Accepted: 02/21/2010] [Indexed: 10/19/2022]
Abstract
Ineffective erythropoiesis in patients with thalassemia intermedia drives extramedullary hematopoietic tumor formation in several parts of the body. Paraspinal involvement has received increasing attention due to the associated morbidity secondary to spinal cord compression. Although the history and physical examination may help narrow the differential diagnosis, radiographic imaging remains essential to confirm the existence of hematopoietic tissue. Characteristic appearance has been observed mainly on magnetic resonance imaging. Several treatment options have been described, including transfusion therapy, laminectomy, radiotherapy, and the use of fetal hemoglobin inducing agents that decrease the hematopoietic drive. However, the ideal management scheme remains controversial. Until large prospective trials evaluate the efficacy and safety of the available treatment options, both in single and in combination therapy, an individualized approach should be entertained.
Collapse
|
8
|
Dewan U, Kumari N, Jaiswal A, Behari S, Jain M. Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review. Indian J Orthop 2010; 44:98-103. [PMID: 20165685 PMCID: PMC2822429 DOI: 10.4103/0019-5413.57281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Extramedullary hemopoiesis (EMH) is a common compensatory phenomenon associated with chronic hemolytic anemia. Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver and kidney; however, other regions such as the spine may also become involved. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine is described. A 62-year-old man presented with paraparesis. Magnetic resonance imaging revealed a large lesion involving the T2-L2 vertebral levels with a large extradural component causing thecal sac compression. Laminectomy with excision of mass was carried out. The histopathology revealed EMH. The patient had no known cause for EMH at the time of diagnosis but, subsequently, a bone marrow examination revealed early myelofibrosis. This case represents the rare occurrence of a large extradural extramedullary hematopoiesis in a patient with no known predisposing factor for hemopoiesis at the time of presentation.
Collapse
Affiliation(s)
- Udita Dewan
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Niraj Kumari
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadesh Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
9
|
|
10
|
Tan TC, Tsao J, Cheung FC. Extramedullary haemopoiesis in thalassemia intermedia presenting as paraplegia. J Clin Neurosci 2002; 9:721-5. [PMID: 12604297 DOI: 10.1054/jocn.2001.1038] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extramedullary haemopoiesis causing spinal cord compression is a rare manifestation of thalassemia. We describe a 17 year old male with thalassemia intermedia who presented with progressive paraplegia and sphincter disturbance. Magnetic resonance imaging revealed an epidural lesion extending from T5 to T8 compressing the spinal cord. The patient recovered completely after surgical decompression with postoperative radiation therapy. Histological examination of the lesion confirmed the diagnosis of extramedullary haemopoiesis. Clinical awareness of this phenomenon with early treatment is essential for optimizing the neurological outcome.
Collapse
Affiliation(s)
- Tze-Ching Tan
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | | | | |
Collapse
|