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Muacevic A, Adler JR, Nogueira-Silva L, Almeida J. Cytomegalovirus and Hemolytic Anemia in an Immunocompetent Adult. Cureus 2022; 14:e31744. [PMID: 36569701 PMCID: PMC9770576 DOI: 10.7759/cureus.31744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/22/2022] Open
Abstract
Hemolytic anemia is an increasingly recognized complication of cytomegalovirus (CMV) infection in immunocompetent patients. Although it is thought to be immune-mediated, other mechanisms have been proposed. The decision to treat is controversial but it may include antiviral and immunosuppressive therapy. We report a case of CMV-induced hemolytic anemia in a previously healthy 55-year-old woman. The patient presented with asthenia and choluria, and laboratory tests showed severe anemia with hyperbilirubinemia and elevated lactate dehydrogenase. A diagnosis of hemolytic anemia was made. Structural, enzymatic, toxic, pharmacological, and neoplastic causes were excluded. The CMV immunoglobulin M was positive, with a negative direct antiglobulin test. The patient had an improvement in clinical and laboratory status without any treatment, and two months later she had a full recovery of the anemia. This case illustrates that CMV infection might be associated with severe organ damage in immunocompetent patients but has an overall good prognosis without any directed treatment.
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Pattanakitsakul P, Sirachainan N, Tassaneetrithep B, Priengprom T, Kijporka P, Apiwattanakul N. Enterovirus 71-Induced Autoimmune Hemolytic Anemia in a Boy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221132283. [PMID: 36277905 PMCID: PMC9580087 DOI: 10.1177/11795476221132283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Autoimmune hemolytic anemia (AIHA) can be induced by recent or concomitant infections. Many infectious agents are postulated to be associated with this condition. Treatment of infection induced AIHA still varies. This report describes a previously healthy Thai boy who developed AIHA associated with enterovirus-71 infection. He was successfully treated with oral prednisone.
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Affiliation(s)
- Ploy Pattanakitsakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Boonrat Tassaneetrithep
- Center of Research Excellence in Immunoregulation, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thongkoon Priengprom
- Center of Research Excellence in Immunoregulation, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimpun Kijporka
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopporn Apiwattanakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Nopporn Apiwattanakul, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Road, Ratchathewi District, Bangkok 10400, Thailand.
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Elliott RP, Freeman BP, Meier JL, El-Herte R. Acute Cytomegalovirus Illness in an Immunocompetent Adult Causing Intravascular Hemolysis and Suspected Hemophagocytic Lymphohistiocytosis. Case Rep Infect Dis 2022; 2022:7949471. [PMID: 35847599 PMCID: PMC9286925 DOI: 10.1155/2022/7949471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Primary cytomegalovirus (CMV) infection of the immunocompetent host usually produces little-to-no illness. Occasionally, the infection results in mononucleosis syndrome, protracted fever, hepatitis, tissue-invasive disease, or Guillain-Barré syndrome. Hemolytic anemia and hemophagocytic lymphohistiocytosis (HLH) are rare complications that have not been reported to co-occur. Having hemolytic anemia in conjunction with more common findings of fever and hepatitis complicates the diagnosis of HLH. Case Presentation. A 34-year-old male with previously good health presented with a prolonged febrile illness, jaundice, and anemia. An extensive work-up during hospitalization revealed intravascular hemolytic anemia, leukopenia, hepatosplenomegaly, and biopsy evidence of extensive lymphohistiocytic infiltration of the liver with microgranulomata and sinusoidal hemophagocytosis. Soluble CD25 level was mildly elevated at 1200.3 pg/mL and the HScore calculation (fever, bicytopenia, hepatosplenomegaly, aspartate aminotransaminase 99 IU/L, ferritin 1570 ng/mL, fibrinogen 488 mg/dL, and triglycerides 173 mg/dL) suggested a moderate probability of reactive HLH. Primary CMV infection was diagnosed based on CMV IgM positivity, low CMV IgG avidity index, and low-grade CMV DNAemia. The CMV antigen was not detected in the liver biopsy, and the bone marrow biopsy was unremarkable. The illness began to improve before he received oral valganciclovir for 5 days, and he was in good health 10 months later. Conclusion Acute CMV illness in an immunocompetent adult can present with hemolytic anemia and clinicopathologic abnormalities consistent with a form fruste of HLH. The illness is likely due to an excessive or unbalanced immune response that may self-correct.
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Affiliation(s)
- Ross P. Elliott
- Internal Medicine Residency Program, MercyOne Medical Center and Clinics, Des Moines, IA 50314, USA
| | | | - Jeffery L. Meier
- Iowa City Veterans Affairs Health Care System, Iowa City, IA 52246, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Rima El-Herte
- Division of Infectious Diseases, Department of Medicine, Creighton, University School of Medicine and CHI Health, Omaha, NE 68124, USA
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Yacoub MS, Doraji M, Yadlapalli S. Cytomegalovirus-Induced Coombs-Positive Hemolysis or Drug-Induced Hemolysis in an Immunocompetent Young Adult. Cureus 2022; 14:e24184. [PMID: 35592217 PMCID: PMC9110076 DOI: 10.7759/cureus.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/05/2022] Open
Abstract
Coombs-positive hemolytic anemia induced by cytomegalovirus (CMV) infection is a rare phenomenon, often not life-threatening in immunocompetent young adults. To date, the pathogenesis of CMV-induced severe hemolysis is still unknown. Here, we discuss a case of a 22-year-old male without significant past medical history who presented with severe hemolytic anemia that required four units of packed red blood cells. Urinalysis showed microscopic hematuria but urine culture and drug screen reported normal findings. Hemoccult result at the bedside was negative. Abdominal ultrasound and computed tomography (CT) imaging all resulted in normal findings except for splenomegaly measured 18 cm. Hematology was consulted which showed a positive direct Coombs antibody test with 3+ IgG and 3+ complement. Peripheral blood smear showed no evidence of schistocytes or occasional teardrop cells but showed toxic granulations and neutrophils indicating an underlying infection. The patient had a bone marrow biopsy which showed erythroid hyperplasia with a slight increase in sideroblast cells; but revealed no evidence of lymphoma, leukemia, or dysplasia. Infectious workup reported negative findings for HIV and hepatitis panel. However, Epstein-Barr virus (EBV) IgM antibodies to viral capsid antigen (VCA) was reported with a value of greater than 160 U/mL. Polymerase chain reaction (PCR) testing for cytomegalovirus (CMV) DNA detected high titers with 481269 IU/mL. The patient initially received intravenous immunoglobulin (IVIG) therapy for five days, antiviral medication for seven days, and high dose therapeutic corticosteroids resulting in stabilization of his blood hemoglobin (Hb) level. Infections commonly underlie secondary autoimmune hemolytic anemia (AIHA), or it can also be a result of therapy that further exacerbates the course of AIHA. Possible CMV manifestations inducing severe hemolytic anemia in immunocompetent individuals have received inadequate attention. CMV serology studies are not collected regularly in patients with hemolysis, so the incidence of this disorder might be under-reported. Thus, clinicians should take initiative to consider an underlying infection in the differential diagnosis of hemolytic anemia before opting for invasive procedures such as bone marrow biopsy. Randomized control trials are needed for a conclusive treatment specific to hemolytic anemia induced by CMV.
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Stockdale T, Hosack T, Griffiths C, Mandal AK, Missouris CG. Lessons of the month 1: Polytrauma in a geriatric patient resulting in reactivation of cytomegalovirus infection and secondary cold agglutinin disease-induced haemolytic anaemia. Clin Med (Lond) 2020; 20:433-435. [PMID: 32554607 DOI: 10.7861/clinmed.2020-0176] [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: 11/27/2022]
Abstract
Haemolysis is a rare but serious complication of cytomegalovirus (CMV) infection, described mostly in immunocompromised patients, the pathogenesis of which is yet to be fully elucidated. We describe a case of Coombs-positive haemolytic anaemia in an older Caucasian immunocompetent woman after polytrauma, resulting from suspected reactivation of CMV infection and secondary cold agglutinin disease. Clinicians should consider CMV infection in the differential diagnosis of haemolytic anaemia in immunocompetent older adults who are admitted with significant musculoskeletal trauma. Early treatment with B-cell depletion therapy to halt cold agglutinin production can be life-saving.
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Bawa MK, Mamman A, Olayinka A, Gidado S, Waziri NE, Balogun MS, Getso KI, Dalhat MM, Nsubuga P, Aliyu N, Bala H, Muhammad H, Haladu S, Shehu UL, Nguku PM. Blood donor safety, prevalence and associated factors for cytomegalovirus infection among blood donors in Minna-Nigeria, 2014. Pan Afr Med J 2019; 32:6. [PMID: 30984327 PMCID: PMC6445335 DOI: 10.11604/pamj.supp.2019.32.1.13297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 12/04/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction human cytomegalovirus (CMV) has remained a cause of morbidity and mortality in pregnancy and immunocompromised patients. CMV is transmissible through blood transfusion. We conducted a descriptive, cross-sectional study to assess blood donor safety and to determine the prevalence and associated factors for CMV infection among blood donors in Minna, Nigeria. Methods all consenting blood donors were screened for CMV antibodies (IgM and IgG) using ELISA kit and haematological indices using a haematological analyzer. We administered structured questionnaires to obtain socio-demographic and socio-economic data. Data were subjected to univariate, bivariate and multivariate statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p < 0.05. Results a total of 345 participantswere recruited, the majority were males 336 (97.4%). Monthly earnings of majority of the blood donors, 136 (40.6%) ranged from ₦18,000 to ₦35,000. The prevalence of CMV infection was 96.2%. The prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6%. Most of the study participants, 274 (79.4%) were family replacement donors. The majority of the blood donors 195 (56.5%) were anaemic (PCV < 36, Hb < 12g/dl). Those with positive CMV were more likely to be of high-income level (OR = 0.32, P = 0.04). Conclusion the seroprevalence of CMV was high with a significant proportion of donors capable of transmitting CMV infection to blood recipients. The majority of the blood donors were anaemic. High income level is associated with CMV infection. Quality of screening for anemia be improved.
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Affiliation(s)
| | | | - Adebola Olayinka
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria.,Ahmadu Bello University, Zaria, Nigeria
| | - Saheed Gidado
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
| | | | | | - Kabir Ibrahim Getso
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria.,Ministry of Health, Kano, Nigeria
| | | | | | - Nuruddeen Aliyu
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
| | - Hussaini Bala
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
| | - Hauwa Muhammad
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
| | - Suleiman Haladu
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
| | - Usman Lawan Shehu
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja-Nigeria
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Hong HJ, Cho YH, Lim JY, Yeom JS, Park JS, Park ES, Seo JH, Woo HO, Youn HS. Cytomegalovirus-Associated Severe Direct Antiglobulin Test Negative Hemolytic Anemia: A Case Report. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyun Jung Hong
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Young Hye Cho
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jae-Young Lim
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Ji Sook Park
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
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Nagashima K, Tanaka H, Nagai Y, Sugita Y. Immune pancytopenia after chemotherapy in a patient with diffuse large B-cell lymphoma. BMJ Case Rep 2016; 2016:bcr-2016-216880. [PMID: 27651408 DOI: 10.1136/bcr-2016-216880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
During treatment for malignant lymphoma, cytopenia can develop for several reasons. In the treatment of cytopenia, various possibilities should be considered because inadequate treatment causes exacerbation of cytopenia and can lead to fatal conditions, such as infection and bleeding. Herein, we describe immune pancytopenia 3 months after the last exposure to chemotherapy in a patient with diffuse large B-cell lymphoma (DLBCL). She suffered from severe pancytopenia after two courses of rituximab and bendamustine therapy for a second relapse of DLBCL. Immune pancytopenia was diagnosed with bone marrow tests and the presence of autoantibodies; it promptly resolved after initiation of prednisolone therapy. Clinicians should be aware of immune cytopenia and monitor for it carefully, even if patients have already finished chemotherapy treatment.
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Affiliation(s)
- Kazuyo Nagashima
- Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Hiroaki Tanaka
- Department of Hematology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yurie Nagai
- Department of Hematology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yasumasa Sugita
- Department of Hematology, Asahi General Hospital, Asahi, Chiba, Japan
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Çelikel E, Tezer H, Kanik-Yuksek S, Gülhan B, Ozkaya-Parlakay A, Yaralı N. Evaluation of 98 immunocompetent children with cytomegalovirus infection: importance of neurodevelopmental follow-up. Eur J Pediatr 2015; 174:1101-7. [PMID: 25762027 DOI: 10.1007/s00431-015-2513-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/17/2015] [Accepted: 03/02/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED This study aims to analyze and evaluate the clinic and demographic features of immunocompetent children that have been diagnosed with cytomegalovirus (CMV) infection. The data of children diagnosed with CMV infection between January 2005 and December 2010 and their follow-ups for 2 years were retrospectively evaluated. Ninety-eight patients were included, and the median age at admission was 5.6 months (5 days-36 months). 54.1% was male. The diagnosis of CMV infection was performed by measurement of serum anti-CMV specific Ig M and IgG titers and PCR method in blood and/or urine. In 3.06% of the patients, congenital infection was detected, whereas possible congenital infection was observed in 36.7% of the patients. Furthermore, 44 patients (44.8%) were detected to have perinatal infection while postnatal infection was spotted in 15.3% of the patients. The common presenting manifestations were prolonged jaundice, diarrhea, vomiting, abdominal distension, skin eruption, and seizure. And the most common physical examination findings were hepatosplenomegaly, microcephaly, jaundice, and petechia. The mainstream laboratory results were elevated transaminases (50%), anemia (30.6%), leukocytosis (27.5%), and thrombocytopenia (18.3%). There were intracranial calcification in 5.1% and eye findings in 5.1%. On follow-up of patients, complete improvement (59.1%), neuromotor developmental delay (11.2%), epilepsy (10.2%), hearing loss (3.06 %), hemolytic anemia (2.04%), and growth retardation (1.02%) were detected. CONCLUSION CMV infection is a significant disease both in congenital and perinatal period. It must be considered that diagnosed patients need to be monitored for a long time with special attention to their neurodevelopmental follow-ups.
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Affiliation(s)
- Elif Çelikel
- Department of Pediatrics, Ankara Hematology Oncology Children's Training and Research Hospital, Ankara, Turkey,
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Ames PRJ, Aw D, Rainey MG. Autoimmune haemolytic anaemia emerging during Campath treatment in a patient with CD5 negative chronic lymphocytic leukaemia. Indian J Hematol Blood Transfus 2014; 30:43-5. [PMID: 25332532 DOI: 10.1007/s12288-013-0239-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/04/2013] [Indexed: 11/27/2022] Open
Abstract
Campath is being employed for the treatment of autoimmune haemolytic anemia (AIHA) whether or not associated to B cell chronic lymphoid leukaemia (CLL). CD5 negative CLL is relatively uncommon and runs an indolent course. We report a CD5 negative CLL patient who developed AIHA associated with cytomegalovirus infection reactivation whilst on treatment with Campath for progressive disease.
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Affiliation(s)
- Paul R J Ames
- Department of Haematology, Inverclyde Royal Hospital, Larkfield Road, Greenock, PA16 0XN Scotland, UK ; Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, 327 Mile End Rd, London, E1 4NS UK
| | - Darren Aw
- Department of Haematology, Inverclyde Royal Hospital, Larkfield Road, Greenock, PA16 0XN Scotland, UK
| | - Mervin G Rainey
- Department of Haematology, Inverclyde Royal Hospital, Larkfield Road, Greenock, PA16 0XN Scotland, UK
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Hosseeini S, Ansari S, Kalantar E, Sabzechian M, Alibeik A, Dorgalaleh A. A fetal hemolytic anemia in a child with cytomegalovirus infection. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2014; 4:78-83. [PMID: 25002930 PMCID: PMC4083205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/20/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Autoimmune hemolytic anemia is a hematologic disorder that is rarely observed in infants and young children. Most of the cases are associated with viral or bacterial infections. In some cases, AIHA can be characterized by a chronic course and an unsatisfactory control of hemolysis, thus requiring prolonged immunosuppressive therapy. CASE REPORT Especially in children younger than 2 years of age, the clinical course of the disease may show either resistance to steroids or dependence on high-dose steroids. We report here an infant fatal autoimmune. CONCLUSION This case suggests that investigation for the presence of CMV infection in infantile AIHA should be considered. Severe hemolysis is rare but could be a potentially life-threatening complication of CMV infection described mostly in immune compromised adults and children.
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Affiliation(s)
- S Hosseeini
- Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
- Gholhak Laboratory, Shariaty Street, Tehran, Iran
| | - Sh Ansari
- Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - E Kalantar
- Immunology Department, Iran University of Medical Sciences, Tehran, Iran
| | - M Sabzechian
- Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - A Alibeik
- Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - A Dorgalaleh
- hematology and blood transfusion Department, Allied Medical School, Tehran Unversity of Medical Sciences, Tehran, Iran
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