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Ghimirey N, Vo PU, Dibb J, Hatch J, Mahesh S. CRE24-050: Microangiopathic Hemolytic Anemia as the Presenting Manifestation of Metastatic Breast Cancer. J Natl Compr Canc Netw 2024; 22:CRE24-050. [PMID: 38579788 DOI: 10.6004/jnccn.2023.7324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
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Orhan Ö, Talay MN. Methemoglobinemia and acute ıntravascular hemolysis after naphthalene poisoning in a pediatric patient. ARCH ARGENT PEDIATR 2024; 122:e202310095. [PMID: 37801672 DOI: 10.5546/aap.2023-10095.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Poisoning by naphthalene is uncommon in children. It is a type of poisoning brought on by ingesting, inhaling, or coming into touch with naphthalene-containing substances on the skin. Patients typically present with an initial onset of dark brown urine, watery diarrhea, and bile vomit. The signs include fever, tachycardia, hypotension, and low pulse oximetry readings even with oxygen support. Hemolytic anemia, methemoglobinemia, renal failure, and hyperbilirubinemia are all detected in blood tests. Erythrocyte transfusion, ascorbic acid, methylene blue, and N-acetylcysteine (NAC) therapies are provided to inpatients in addition to symptomatic treatment. We present a 23-month-old male patient who developed methemoglobinemia and acute ıntravascular hemolysis, who was followed up in the intensive care unit for five days due to naphthalene intoxication. Although naphthalene poisoning is very rare, it should be known that it has fatal consequences, and more care should be taken in its use and sale.
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Affiliation(s)
- Özhan Orhan
- Mardin Artuklu University Faculty of Medicine, Turkey
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Isomura Y, Tamiya H. Alectinib-induced Hemolytic Anemia with Positive Direct Antiglobulin Test in a Patient with Lung Adenocarcinoma: A Possible Drug-drug Interaction Effect. Intern Med 2024; 63:711-715. [PMID: 37438141 PMCID: PMC10982000 DOI: 10.2169/internalmedicine.1286-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/02/2023] [Indexed: 07/14/2023] Open
Abstract
Recent studies have reported that direct antiglobulin test (DAT) results were negative in cases of alectinib-induced hemolytic anemia with abnormal red blood cell (RBC) morphology. We herein report the case of a 72-year-old female patient who was diagnosed with alectinib-induced hemolytic anemia who - in contrast to previous reports - showed a positive DAT result. After discontinuing famotidine and alectinib, the DAT results turned negative; however, when alectinib was resumed, hemolysis recurred. Although alectinib-induced hemolytic anemia has been previously thought to be associated with abnormal morphological changes of the RBCs, we suggest that alectinib-induced anemia may manifest as DAT-positive immune hemolytic anemia because of a complementary effect with other drugs.
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Affiliation(s)
- Yuta Isomura
- Department of Respiratory Medicine, Tokushima Prefectural Miyoshi Hospital, Japan
| | - Hiroyuki Tamiya
- Department of Respiratory Medicine, Tokushima Prefectural Miyoshi Hospital, Japan
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Yaguchi A, Nakagawa M, Endo A, Fujimura J, Shimizu T. Green Urine in the Diaper: A Key Indicator for Diagnosing Hemolytic anemia. J Pediatr 2024; 266:113856. [PMID: 38006966 DOI: 10.1016/j.jpeds.2023.113856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Akinori Yaguchi
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mayu Nakagawa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Amane Endo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Junya Fujimura
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Kubo A, Murakami S, Iwata T. Drug Interaction-induced Hemolytic Anemia: An Unresolved Diagnostic Process. Intern Med 2024; 63:631-633. [PMID: 37438134 PMCID: PMC10982025 DOI: 10.2169/internalmedicine.2119-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Akihito Kubo
- Oncology Center, Aichi Medical University Hospital, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Japan
| | - Satsuki Murakami
- Oncology Center, Aichi Medical University Hospital, Japan
- Department of Hematology, Aichi Medical University, Japan
| | - Takashi Iwata
- Oncology Center, Aichi Medical University Hospital, Japan
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Kitamura W, Kobayashi H, Iseki A, Wada H, Maeda Y, Kuyama S. Cold agglutinin-induced acrocyanosis without hemolytic anemia. Ann Hematol 2024; 103:681-683. [PMID: 37940715 DOI: 10.1007/s00277-023-05538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Wataru Kitamura
- Department of Hematology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan.
- Department of Hematology, Oncology and Respiratory Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Hiroki Kobayashi
- Department of Hematology, Oncology and Respiratory Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Akiko Iseki
- Department of Pathology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
| | - Hideho Wada
- Department of Hematology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
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Zhao ZY, Li JY, Huang WH, Qiu LL, Qian BH, Zha ZS. [Child with sitosterolemia initially presenting with hemolytic anemia and thrombocytopenia: a case repore and literrature review]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:90-93. [PMID: 38527845 DOI: 10.3760/cma.j.cn121090-20230915-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
This article focuses on a case study of sitosterolemia in a child who initially presented with hemolytic anemia and thrombocytopenia. Sitosterolemia is a rare autosomal recessive lipid metabolism disorder, difficult to diagnose due to its non-typical clinical manifestations. The 8-year-old patient was initially misdiagnosed with pyruvate kinase deficiency. Comprehensive biochemical and molecular biology analyses, including gene sequencing, eventually led to the correct diagnosis of sitosterolemia. This case highlights the complexity and diagnostic challenges of sitosterolemia, emphasizing the need for increased awareness and accurate diagnosis in patients presenting with similar symptoms.
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Affiliation(s)
- Z Y Zhao
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
| | - J Y Li
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
| | - W H Huang
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
| | - L L Qiu
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
| | - B H Qian
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
| | - Z S Zha
- Department of Blood Transfusion, Changhai Hospital, The First Affiliated Hospital of PLA Naval Medical University, Research &Innovation Base of Pediatric Hemolytic Anemia, Shanghai 200433, China
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Dofuku M, Tamura D, Mizobe M, Kurane K, Hayashi Y, Kimura H, Shimada A. Severe hemolytic anemia in a glucose-6-phosphate dehydrogenase-deficient child with COVID-19. Pediatr Int 2024; 66:e15717. [PMID: 38217100 DOI: 10.1111/ped.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Mika Dofuku
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Daisuke Tamura
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Marina Mizobe
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Yuriko Hayashi
- Department of Health Science, Gunma Paz University Graduate School, Takasaki, Gunma, Japan
| | - Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School, Takasaki, Gunma, Japan
| | - Akira Shimada
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
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Gong Y, Zheng Q, Long S, Chen H, Liu W, Li C. The first Chinese with Hb Chile leading to chronic anemia and methemoglobinemia: a case report. BMC Pediatr 2023; 23:639. [PMID: 38110882 PMCID: PMC10726640 DOI: 10.1186/s12887-023-04462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Hemoglobin (Hb) Chile [β28(B10) Leu > Met; HBB: c.85 C > A] is a rare hemoglobin variant caused by a missense mutation in the HBB gene. Only one case of Hb Chile has been reported worldwide so far. It is an unstable hemoglobin, characterized by cyanosis associated with chronic methemoglobinemia and hemolytic anemia induced by sulfonamides or methylene blue. CASE PRESENTATION A 9-year-3-month-old girl had mild anemia of unknown etiology for more than 6 years. She had a slight pallor without other symptoms or signs. The complete blood count revealed normocytic normochromic anemia with a sometimes-elevated reticulocyte count, and the bone marrow cytology showed marked erythroid hyperplasia, but the tests related to hemolysis were normal. Therefore, the whole exome sequencing was performed and showed a heterozygous mutation for HBB: c.85 C > A. With asymptomatic methemoglobinemia confirmed later, she was eventually diagnosed with Hb Chile. CONCLUSIONS This is the first report of Hb Chile in China and the second worldwide. This case shows that Hb Chile is clinically heterogeneous and difficult to diagnose and expands our understanding on the clinical and hematological traits of the disease.
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Affiliation(s)
- Yao Gong
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Qinxin Zheng
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Sili Long
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Hongying Chen
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Wenjun Liu
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Cheng Li
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China.
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Jesudas R, Takemoto CM. Where have all the platelets gone? HIT, DIC, or something else? Hematology Am Soc Hematol Educ Program 2023; 2023:43-50. [PMID: 38066886 PMCID: PMC10727081 DOI: 10.1182/hematology.2023000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Thrombocytopenia in ill children is common; accurately diagnosing the underlying etiology is challenging and essential for appropriate management. Triggers for accelerated consumption of platelets are numerous; common downstream mechanisms of clearance include platelet trapping in microvascular thrombi, phagocytosis, and platelet activation. Thrombocytopenia with microangiopathic hemolytic anemia (MAHA) is frequently due to disseminated intravascular coagulation. Thrombotic microangiopathy (TMA) is a subgroup of MAHA. Specific TMA syndromes include thrombotic thrombocytopenic purpura, complement-mediated TMA (CM-TMA), and Shiga toxin-mediated hemolytic uremic syndrome. Isolated thrombocytopenia is characteristic of immune thrombocytopenia; however, concomitant cytopenias are frequent in critically ill patients, making the diagnosis difficult. Immune thrombocytopenia with large vessel thrombosis is a feature of heparin-induced thrombocytopenia and antiphospholipid antibody syndrome. In addition, thrombocytopenia is common with macrophage activation, which is characteristic of hemophagocytic lymphohistiocytosis. While thrombocytopenia in ill patients can be driven by hypoproliferative processes such as myelosuppression and/or bone marrow failure, this review will focus on consumptive thrombocytopenia due to immune and nonimmune causes.
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Fraga A, Conde AR, Araújo B, Silva A. Pyknocytosis, a rare form of neonatal haemolytic anaemia. An Pediatr (Barc) 2023; 99:455-456. [PMID: 37981561 DOI: 10.1016/j.anpede.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Ana Fraga
- Unidad de Cuidados Especiales Neonatales, Servicio de Pediatría, Hospital de Braga EPE, Braga, Portugal.
| | - Ana Raquel Conde
- Servicio de Patología Clínica, Hospital de Braga EPE, Braga, Portugal
| | - Beatriz Araújo
- Servicio de Patología Clínica, Hospital de Braga EPE, Braga, Portugal
| | - Albina Silva
- Unidad de Cuidados Especiales Neonatales, Servicio de Pediatría, Hospital de Braga EPE, Braga, Portugal
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Xu H, Wang Y, Gao H. [Advances in pathophysiology, diagnosis and treatment of adult severe-associated thrombotic microangiopathy]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2023; 35:1335-1339. [PMID: 38149400 DOI: 10.3760/cma.j.cn121430-20230808-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Thrombotic microangiopathy (TMA) is a group of highly heterogeneous, acute and severe clinicopathological syndromes, characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and ischemic injury of end organs. TMA has the characteristics of dangerous condition, multiple organ involvement and high mortality. Patients with severe TMA need to be admitted to intensive care unit (ICU) for organ function support therapy. Early and rapid evaluation, differential diagnosis, and timely and effective treatment are the key to improve the prognosis of TMA patients. Here, we review the pathophysiological changes, diagnosis differential diagnosis, and treatment of the severe TMA in adult.
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Affiliation(s)
- Hua Xu
- Department of Critical Care Medicine, Tianjin First Center Hospital, Key Laboratory for Critical Care Medicine of the Ministry of Health, Emergency Medicine Research Institute, Tianjin 300192, China. Corresponding author: Gao Hongmei,
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Scully M, Rayment R, Clark A, Westwood JP, Cranfield T, Gooding R, Bagot CN, Taylor A, Sankar V, Gale D, Dutt T, McIntyre J, Lester W. A British Society for Haematology Guideline: Diagnosis and management of thrombotic thrombocytopenic purpura and thrombotic microangiopathies. Br J Haematol 2023; 203:546-563. [PMID: 37586700 DOI: 10.1111/bjh.19026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
The objective of this guideline is to provide healthcare professionals with clear, up-to-date and practical guidance on the management of thrombotic thrombocytopenic purpura (TTP) and related thrombotic microangiopathies (TMAs), including complement-mediated haemolytic uraemic syndrome (CM HUS); these are defined by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and small vessel thrombosis. Within England, all TTP cases should be managed within designated regional centres as per NHSE commissioning for highly specialised services.
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Affiliation(s)
- M Scully
- Department of Haematology, UCLH and Haematology Programme, University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
| | - R Rayment
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Clark
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - T Cranfield
- Department of Haematology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - R Gooding
- Haematology Department, Belfast City Hospital, Belfast H&SC Trust, Belfast, UK
| | - C N Bagot
- Glasgow Royal Infirmary, Glasgow, UK
| | - A Taylor
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - V Sankar
- Department of Critical Care Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gale
- Department of Renal Medicine, University College London, London, UK
| | - T Dutt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - W Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
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Restivo GA, Scalzo S, Di Palermo A. Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review. J Pediatr Hematol Oncol 2023; 45:e993-e995. [PMID: 37526400 DOI: 10.1097/mph.0000000000002734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023]
Abstract
Hemolytic anemia could be caused by several conditions, depending on intrinsic or extrinsic defects of the erythrocyte. The latter group includes mechanical intravascular hemolysis, generally related to malfunctioning prosthetic heart valves or, rarely, heart valves repair. We describe a case of a child with Down syndrome, who developed hemolytic anemia after mitral valve repair. We observed that this condition is a rare complication in pediatrics, with only 7 cases reported in literature. Mechanical hemolysis should always be considered in the differential diagnosis of a new-onset hemolytic anemia, especially in patients with valvular heart disease, undergoing cardiac surgery.
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Affiliation(s)
| | - Simona Scalzo
- Emergency Department, ARNAS Ospedali Civico, Di Cristina e Benfratelli
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Ma X, Ju C, Liu X, Tian Y, Wu J, Li Y. Idiopathic pulmonary haemosiderosis misdiagnosed as haemolytic anaemia: a case report. J Int Med Res 2023; 51:3000605231210402. [PMID: 37903315 PMCID: PMC10617271 DOI: 10.1177/03000605231210402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
Idiopathic pulmonary haemosiderosis is a rare disease primarily affecting children. The condition is characterized by widespread bleeding from alveolar capillaries, resulting in symptoms such as haemoptysis, shortness of breath and iron deficiency anaemia. However, it is not a specific disease and sometimes can manifest solely as anaemia, which may be easily overlooked and misdiagnosed. The purpose of this case report was to describe a 1-year-old boy who exhibited haemolytic anaemia as the only symptom of idiopathic pulmonary haemosiderosis, with the intention of offering clinical insights into the precise diagnosis and subsequent management of this rare and easily misdiagnosed disease. Clinicians should keep idiopathic pulmonary haemosiderosis in mind when evaluating children with haemolytic anaemia and promptly initiate testing and treatment to prevent misdiagnosis and improve outcomes.
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Affiliation(s)
- Xueqin Ma
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Changxi Ju
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Xiaotong Liu
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Ying Tian
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Wu
- Department of Paediatric Intensive Care Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Yuanxiao Li
- Department of Paediatric Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
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Rodas MA, Astorquizaga L, Lisanti C, Rojas S, de Mena A. Thrombotic thrombocytopenic purpura in pediatrics. A case report. ARCH ARGENT PEDIATR 2023; 121:e202202758. [PMID: 36724140 DOI: 10.5546/aap.2022-02758.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Thrombotic thrombocytopenic purpura is a rare disease in pediatrics, but it has a high mortality if not managed in an adequate and timely manner. It is characterized by microangiopathic hemolytic anemia associated with neurological, cardiac, abdominal, and less frequently, renal signs and symptoms; it may be accompanied by fever. In children, diagnosis is based on clinical and laboratory findings. ADAMTS13 activity < 10% supports the diagnosis but does not confirm it and, given its severity, the result should not delay treatment initiation. Here we describe the case of a previously healthy 15-year-old female patient with neurological signs associated with hemolytic anemia and thrombocytopenia. During hospitalization, she was diagnosed with acquired thrombotic thrombocytopenic purpura.
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Affiliation(s)
- María A Rodas
- Clinical Pediatrics, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Lucía Astorquizaga
- Clinical Pediatrics, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Camila Lisanti
- Clinical Pediatrics, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Sonia Rojas
- Clinical Pediatrics, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Arturo de Mena
- Clinical Pediatrics, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
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Zhang X, Gao BX, Guo CY, Su T. A 71-year-old male with a life-threatening recurrence of hemolytic anemia, thrombocytopenia, and acute kidney injury after pembrolizumab therapy: a case report. BMC Geriatr 2023; 23:478. [PMID: 37553570 PMCID: PMC10410872 DOI: 10.1186/s12877-023-04181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, their use has been restricted in patients with preexisting autoimmune diseases due to concerns about increased risk of immune-related adverse events (irAEs). CASE PRESENTATION We present a case of a patient with stage IV lung adenocarcinoma and a history of complement-mediated autoimmune hemolytic anemia in remission. After receiving a single dose of pembrolizumab, the patient experienced life-threatening recurrent hemolytic anemia, de novo thrombocytopenia, diarrhea, myocarditis, and acute kidney injury. Laboratory tests confirmed the diagnosis of Evan's syndrome, with positive PAIgG and direct antiglobulin test. Treatment with intravenous methylprednisolone at a dose of 2 mg/kg resulted in a favorable response, with resolution of symptoms and rapid recovery of kidney function. The probable cause of pre-renal hypoperfusion (evidenced by a BUN-to-creatinine ratio of 48.1) leading to acute tubular injury was attributed to pembrolizumab-induced diarrhea. CONCLUSIONS This case illustrates a life-threatening recurrence of complement-mediated autoimmune hemolytic anemia induced by ICIs. Clinicians should carefully consider the expected efficacy and potential toxicity before initiating ICIs therapy in patients with preexisting autoimmune diseases. Additionally, the occurrence of acute kidney injury during ICIs therapy adds complexity and requires careful differential diagnosis.
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Affiliation(s)
- Xin Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China
- Institute of Nephrology, Peking University, No.8 Xishuku Street, Beijing, Xicheng District, 100034, People's Republic of China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, People's Republic of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases Chinese Academy of Medical Sciences, 100034, Beijing, PR China
| | - Bi-Xia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China
- Institute of Nephrology, Peking University, No.8 Xishuku Street, Beijing, Xicheng District, 100034, People's Republic of China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, People's Republic of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases Chinese Academy of Medical Sciences, 100034, Beijing, PR China
| | - Cui-Yan Guo
- Department of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China.
- Institute of Nephrology, Peking University, No.8 Xishuku Street, Beijing, Xicheng District, 100034, People's Republic of China.
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, People's Republic of China.
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, People's Republic of China.
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases Chinese Academy of Medical Sciences, 100034, Beijing, PR China.
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19
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Risinger M, Kim PS, Rodriguez RX, Narvaez Rivas M, Setchell KDR, Zhang W, Kalfa TA. Hemolytic anemia and macrothrombocytopenia: A lipid problem? Am J Hematol 2023; 98:1335-1340. [PMID: 36974979 PMCID: PMC10523966 DOI: 10.1002/ajh.26916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Mary Risinger
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Phyllis S Kim
- Hematology and Medical Oncology Department, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Roberto X Rodriguez
- Hematology and Medical Oncology Department, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Monica Narvaez Rivas
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kenneth D R Setchell
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Wenying Zhang
- Genetics and Genomics Diagnostic Laboratory, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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20
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Koga M, Kameyama M, Okumiya T. Estimation of mean erythrocyte age using HbA1c or HbA1c/glycated albumin for evaluation of anemia severity. J Clin Lab Anal 2023; 37:e24947. [PMID: 37518970 PMCID: PMC10492451 DOI: 10.1002/jcla.24947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/02/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) levels are low in patients with hemolytic anemia, as HbA1c reflects mean erythrocyte age (MRBC ). Erythrocyte creatine (EC) is a hemolytic indicator that also reflects MRBC . We previously reported an equation for estimating MRBC using EC (EC-MRBC ). AIMS In this study, EC-MRBC was compared to the HbA1c level expressed in the International Federation of Clinical Chemistry and Laboratory Medicine units (iA1c) and to the iA1c/glycated albumin (GA) ratio to estimate MRBC . METHODS This study included 238 subjects, including patients with hemolytic anemia and/or type 2 diabetes mellitus (T2DM). RESULTS In non-diabetic individuals, both iA1c and iA1c/GA showed a strong positive correlation with EC-MRBC (p < 0.0001). The equations to estimate iA1c-MRBC and iA1c/GA-MRBC derived from the regression equations between EC-MRBC and iA1c, and EC-MRBC and iA1c/GA in nondiabetic individuals were 1.45 × iA1c and 20.0 × iA1c/GA, respectively. iA1c-MRBC and iA1c/GA-MRBC in non-diabetic individuals without hemolytic anemia were 57.6 ± 4.0 and 57.1 ± 6.4 days, respectively, and iA1c/GA-MRBC in T2DM patients without hemolytic anemia was 56.0 ± 8.8 days.; no significant difference was seen in the comparisons. CONCLUSIONS The MRBC can be estimated using iA1c or iA1c/GA in non-diabetic individuals, and iA1c/GA in T2DM patients.
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Affiliation(s)
- Masafumi Koga
- Department of Internal MedicineHakuhokai Central HospitalAmagasakiJapan
| | - Masahi Kameyama
- Research Team for NeuroimagingTokyo Metropolitan Institute for Geriatrics and GerontologyTokyoJapan
| | - Toshika Okumiya
- Department of Medical Laboratory Science, Faculty of Health SciencesKochi Gakuen UniversityKochiJapan
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21
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Lee AI, Heidari P, Fenves AZ, Bardia A, Ta R. Case 8-2023: A 71-Year-Old Woman with Refractory Hemolytic Anemia. N Engl J Med 2023; 388:1032-1041. [PMID: 36920760 PMCID: PMC10133839 DOI: 10.1056/nejmcpc2211370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Alfred I Lee
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Pedram Heidari
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Andrew Z Fenves
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Aditya Bardia
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Robert Ta
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
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22
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Abstract
Flutamide-induced haemolytic anaemia is rare but can be fatal. We describe the case of an 88-year-old man with prostatic carcinoma who, in addition to clinically obvious jaundice, developed haemolytic anaemia after undergoing treatment with flutamide for 5 days. When flutamide was replaced with temporary adrenocortical hormone treatment and blood transfusion, the blood indices and liver function of the patient improved gradually. We emphasise the need for routine monitoring of blood counts for patients undergoing flutamide treatment, and highlight the importance of discontinuing flutamide immediately when haemolytic anaemia occurs.
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Affiliation(s)
- Yu Sun
- Department of Pharmacy, Ningbo City First Hospital, Ningbo, Zhejiang, China
| | - Suyan Zhu
- Department of Pharmacy, Ningbo City First Hospital, Ningbo, Zhejiang, China
| | - Qi Hu
- Department of Pharmacy, Ningbo City First Hospital, Ningbo, Zhejiang, China
| | - Ping Xu
- Department of Pharmacy, Ningbo City First Hospital, Ningbo, Zhejiang, China
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23
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Michael HT, Mohan D, Aljaghber H, Alalawi F, Railey M, Alhadari A. Topical Henna Application Causing Acute Kidney Injury and Acute Hemolytic Anemia. Saudi J Kidney Dis Transpl 2023; 34:178-186. [PMID: 38146728 DOI: 10.4103/1319-2442.391897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Body art by henna staining is a practice that is widely prevalent in the Middle East and Africa, and has been known to be in vogue for hundreds of years. The practice is also significant as a ceremonial custom for weddings and social gatherings. However, due to its natural components (Lawsone) and additives, including para-phenylene-diamine (PPD), henna has also been associated with a number of health hazards, including acute hemolysis and acute kidney injury (AKI). We report in this case, a female patient who presented with AKI and acute hemolytic anemia following excessive pre-wedding henna staining of her arms and legs.
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Affiliation(s)
| | - Dhanya Mohan
- Department of Nephrology, Dubai Hospital, Dubai, United Arab Emirates
| | - Hind Aljaghber
- Department of Internal Medicine, Dubai Hospital, Dubai, United Arab Emirates
| | - Fakhriya Alalawi
- Department of Nephrology, Dubai Hospital, Dubai, United Arab Emirates
| | - Mohammed Railey
- Department of Nephrology, Dubai Hospital, Dubai, United Arab Emirates
| | - Amna Alhadari
- Department of Nephrology, Dubai Hospital, Dubai, United Arab Emirates
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24
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Eichenauer DA, Kochanek M. [Hemolytic anemia in emergency and intensive care medicine]. Med Klin Intensivmed Notfmed 2023; 118:30-34. [PMID: 36598517 DOI: 10.1007/s00063-022-00980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023]
Abstract
Hemolytic anemia (HA) is caused by premature destruction or degradation of red blood cells (RBC). Low hemoglobin, suppressed haptoglobin, reticulocytosis as well as an elevation of lactate dehydrogenase and bilirubin are common laboratory findings in HA. Intracorpuscular HA due to defects of the RBC themselves are distinguished from extracorpuscular HA due to external factors. Severity of symptoms such as fatigue and dyspnea depend on the degree of anemia. For optimal treatment of HA, a detailed evaluation of the patient history (including hereditary RBC defects, B symptoms and travel history) is necessary. Additional diagnostics (hematological diagnostics, infectious disease diagnostics, immunological diagnostics, computed tomography [CT] scan) should be performed according to the patient's individual requirements. Treatment of HA depends on the etiology. If HA is immune-mediated, immunosuppressive therapy is indicated, whereas HA due to infections usually improves after adequate anti-infective therapy. Anti-infective therapy should also be considered in patients with sickle cell disease who present with severe HA. In general, HA can be treated effectively in most cases.
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Affiliation(s)
- Dennis A Eichenauer
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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25
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Mehrabi Sisakht J, Mehri M, Najmabadi H, Azarkeivan A, Neishabury M. Genetic Diagnosis of Pyruvate Kinase Deficiency in Undiagnosed Iranian Patients with Severe Hemolytic Anemia, using Whole Exome Sequencing. Arch Iran Med 2022; 25:691-697. [PMID: 37542401 PMCID: PMC10685872 DOI: 10.34172/aim.2022.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/28/2021] [Indexed: 08/06/2023]
Abstract
BACKGROUND After ruling out the most common causes of severe hemolytic anemia by routine diagnostic tests, certain patients remain without a diagnosis. The aim of this study was to elucidate the genetic cause of the disease in these patients using next generation sequencing (NGS). METHODS Four unrelated Iranian families including six blood transfusion dependent cases and their parents were referred to us from a specialist center in Tehran. There was no previous history of anemia in the families and the parents had no abnormal hematological presentations. All probands presented severe congenital hemolytic anemia, neonatal jaundice and splenomegaly. Common causes of hemolytic anemia were ruled out prior to this investigation in these patients and they had no diagnosis. Whole exome sequencing (WES) was performed in the probands and the results were confirmed by Sanger sequencing and subsequent family studies. RESULTS We identified five variants in the PKLR gene, including a novel unpublished frameshift in these families. These variants were predicted as pathogenic according to the ACMG guidelines by Intervar and/or Varsome prediction tools. Subsequent family studies by Sanger sequencing supported the diagnosis of pyruvate kinase deficiency (PKD) in six affected individuals and the carrier status of disease in their parents. CONCLUSION These findings show that PKD is among the rare blood disorders that could remain undiagnosed or even ruled out in Iranian population without performing NGS. This could be due to pitfalls in clinical, hematological or biochemical approaches in diagnosing PKD. Furthermore, genotyping PKD patients in Iran could reveal novel mutations in the PKLR gene.
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Affiliation(s)
- Jafar Mehrabi Sisakht
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maghsood Mehri
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hossein Najmabadi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Kariminejad-Najmabadi Pathology & Genetics Centre, Tehran, Iran
| | - Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Maryam Neishabury
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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26
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Barron K, Ramadas P, Grewal US. Hemolytic anemia in a patient with cirrhosis: Hiding in the smear! Eur J Intern Med 2022; 101:112-113. [PMID: 35346568 DOI: 10.1016/j.ejim.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kyle Barron
- Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Poornima Ramadas
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Udhayvir Singh Grewal
- Division of Internal Medicine, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States.
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27
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Nishikado M, Awaguni H, Shinozuka J, Okumura K, Imashuku S. Puzzling (IRIDA-Like and Hemolytic) Anemia in a Child With Idiopathic Pulmonary Hemosiderosis. J Pediatr Hematol Oncol 2022; 44:191-193. [PMID: 34966096 DOI: 10.1097/mph.0000000000002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
Before the diagnosis of idiopathic pulmonary hemosiderosis (IPH), unexplained or puzzling anemia may precede and delay in the diagnosis of pediatric IPH is common. A 5.8 years old female child initiated with iron-refractory iron deficiency anemia-like iron deficiency and hemolytic anemia and at 6.8 years of age IPH was materialized, when the patient showed the triad signs of IPH with hemosiderin-laden alveolar macrophages in gastric aspirate. Although time to the diagnosis was previously reported to be ranged from 16 to 30 months, in our case it took 12 months from the initial anemia to IPH diagnosis.
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Affiliation(s)
| | | | | | | | - Shinsaku Imashuku
- Departments of Pediatrics
- Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
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28
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Arumugam SK, Ramalingam R, Ramalingam R. A Male Infant with Cholestatic Jaundice, Hemolytic Anemia, and Thrombocytopenia. Neoreviews 2022; 23:e121-e124. [PMID: 35102384 DOI: 10.1542/neo.23-2-e121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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29
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Ramirez de Oleo IE, Mejia Saldarriaga M, Johnson BK. Association of Hydroxychloroquine use and Hemolytic Anemia in Patients With Low Levels of Glucose-6-Phosphate Dehydrogenase. J Clin Rheumatol 2022; 28:e23-e25. [PMID: 32956151 DOI: 10.1097/rhu.0000000000001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase deficiency (G6PD) is linked to hemolytic anemia with certain medications and is the most common enzyme deficiency worldwide. Although the American College of Rheumatology does not recommend routine testing for G6PD prior to initiation of hydroxychloroquine (HCQ), the package insert for HCQ does recommend careful use in patients with G6PD deficiency. METHODS We identified eligible subjects seen at our tertiary care, urban medical center between 1997 and 2018. Case records were analyzed for G6PD deficiency, HCQ use, length of exposure to HCQ, demographic characteristics, and laboratory evidence of hemolysis. RESULTS We found 5264 patients who were prescribed HCQ, of which 49.5% (2605 patients) were screened for G6PD deficiency. Of the screened patients, 36 were found to be G6PD-deficient. Of the G6PD-deficient patients, 18 were exposed to HCQ. No evidence of hemolysis was found in these exposed patients. CONCLUSIONS Despite more than 500 months of cumulative exposure time to HCQ, there were no cases of hemolysis. These findings are in line with recently published data and suggest that this interaction is not associated with clinically significant hemolysis in our population of mainly African American and Hispanic patients. Limitations to our study are potential bias due to case review design and lack of prior assessment of episodes of hemolysis before HCQ exposure. A high proportion of our patients were Hispanic, suggesting no increase of adverse events in this subgroup. A larger longitudinal trial would be needed to definitively answer the question of the safety of HCQ in G6PD-deficient patients.
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30
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Luzzatto L. Diagnosis and clinical management of enzymopathies. Hematology Am Soc Hematol Educ Program 2021; 2021:341-352. [PMID: 34889365 PMCID: PMC8791163 DOI: 10.1182/hematology.2021000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
At least 16 genetically determined conditions qualify as red blood cell enzymopathies. They range in frequency from ultrarare to rare, with the exception of glucose-6-phosphate dehydrogenase deficiency, which is very common. Nearly all these enzymopathies manifest as chronic hemolytic anemias, with an onset often in the neonatal period. The diagnosis can be quite easy, such as when a child presents with dark urine after eating fava beans, or it can be quite difficult, such as when an adult presents with mild anemia and gallstones. In general, 4 steps are recommended: (1) recognizing chronic hemolytic anemia; (2) excluding acquired causes; (3) excluding hemoglobinopathies and membranopathies; (4) pinpointing which red blood cell enzyme is deficient. Step 4 requires 1 or many enzyme assays; alternatively, DNA testing against an appropriate gene panel can combine steps 3 and 4. Most patients with a red blood cell enzymopathy can be managed by good supportive care, including blood transfusion, iron chelation when necessary, and splenectomy in selected cases; however, some patients have serious extraerythrocytic manifestations that are difficult to manage. In the absence of these, red blood cell enzymopathies are in principle amenable to hematopoietic stem cell transplantation and gene therapy/gene editing.
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Affiliation(s)
- Lucio Luzzatto
- Correspondence Lucio Luzzatto, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, 65001 Dar es Salaam, Tanzania; e-mail:
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31
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Botero JP, Reese JA, George JN, McIntosh JJ. Severe thrombocytopenia and microangiopathic hemolytic anemia in pregnancy: A guide for the consulting hematologist. Am J Hematol 2021; 96:1655-1665. [PMID: 34424560 PMCID: PMC8616841 DOI: 10.1002/ajh.26328] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022]
Abstract
A hematologist receives a call from a maternal-fetal medicine (MFM) physician about a previously healthy patient who became ill at 25 weeks' gestation. Her mental status is deteriorating. There are signs of fetal distress. Platelet count and hemoglobin are falling. The MFM physician is considering the hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. For the hematologist, everything seems unfamiliar. Our goal is to provide hematologists with the fundamental knowledge required for understanding and managing these patients who become suddenly and seriously ill during pregnancy and in whom thrombocytopenia and microangiopathic hemolytic anemia are part of their presentation.
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Affiliation(s)
- Juliana Perez Botero
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Versiti (Blood Center of Wisconsin), Milwaukee, Wisconsin, USA
| | - Jessica A. Reese
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - James N. George
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, USA
- Hematology-Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer J. McIntosh
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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32
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Gustafsson L, James S, Zhang Y, Thozhuthumparambil KP. Fatal case of delayed-onset haemolytic anaemia after oral artemether-lumefantrine. BMJ Case Rep 2021; 14:e245718. [PMID: 34799392 PMCID: PMC8606760 DOI: 10.1136/bcr-2021-245718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/03/2022] Open
Abstract
Artemisinin derivatives are used globally in the management of falciparum malaria. Postartemisinin delayed haemolysis (PADH) is a recognised adverse event contributing to severe anaemia. To the best of our knowledge, we report the first recorded fatal case of PADH. A 60-year-old woman presented with two episodes of collapse at home and feeling generally unwell. She had recently been treated for uncomplicated falciparum malaria 1 month prior with artemether 80 mg/lumefantrine 480 mg in Congo. Her results on admission revealed an anaemia (haemoglobin 43 g/L), raised lactate dehydrogenase and positive direct antiglobulin test that suggested an intravascular haemolytic process. She made a capacitous decision to refuse blood products in line with her personal beliefs. Despite best supportive treatment, she did not survive. This case highlights the importance of postartemisinin follow-up and should encourage discussion and careful consideration of its use in the context of lack of access to/patient refusal of blood products.
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Affiliation(s)
- Lotta Gustafsson
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sunil James
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Yimeng Zhang
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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33
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Shingu M, Ishimaru N, Ohnishi J, Mizuki S, Kanzawa Y, Kawano K, Nakajima T, Sano N, Kinami S. Hemolytic Anemia in a Patient with Subacute Bacterial Endocarditis by Cardiobacterium hominis. Intern Med 2021; 60:3489-3495. [PMID: 34024848 PMCID: PMC8627805 DOI: 10.2169/internalmedicine.6186-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hemolytic anemia is a rarely occurring manifestation of native valve infective endocarditis. We herein report an afebrile patient with hemolytic anemia caused by Cardiobacterium hominis endocarditis. A 60-year-old Japanese man had a history of aortic root replacement and the gradual onset of general fatigue. He had hemolytic anemia. Blood cultures detected C. hominis. A transthoracic echocardiogram showed aortic valve vegetation and periannular abscess with perforation of the non-coronary cusp. Intravascular hemolysis recovered after antimicrobial therapy, surgical removal of the vegetation and abscess, and aortic valve replacement. Subacute endocarditis should be considered if patients develop hemolytic anemia with signs of chronic inflammation without a fever.
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Affiliation(s)
- Motohiro Shingu
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Jun Ohnishi
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Shimpei Mizuki
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Kei Kawano
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Nakajima
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Nobuya Sano
- Department of Pathology, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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Sivasankaran M, Reddy VK, Kumar V, Munirathnam D. Hereditary Non-Spherocytic Hemolytic Anemia (HNSHA): Four Children with Rare Hereditary Red Cell Enzymopathies. Indian Pediatr 2021. [PMID: 34636333 PMCID: PMC8549597 DOI: 10.1007/s13312-021-2339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Meena Sivasankaran
- Department of Pediatric Haemato-Oncology and Bone Marrow Transplantation, Kanchi Kamakoti CHILD Trust Hopsital, Numgambakkam, Chennai, Tamil Nadu.
| | - Vamsi Krishna Reddy
- Department of Pediatrics, Kanchi Kamakoti CHILD Trust Hopsital, Numgambakkam, Chennai, Tamil Nadu
| | - Vimal Kumar
- Department of Pediatric Haemato-Oncology and Bone Marrow Transplantation, Kanchi Kamakoti CHILD Trust Hopsital, Numgambakkam, Chennai, Tamil Nadu
| | - Deenadayalan Munirathnam
- Department of Pediatric Haemato-Oncology and Bone Marrow Transplantation, Kanchi Kamakoti CHILD Trust Hopsital, Numgambakkam, Chennai, Tamil Nadu
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35
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Beneke LL, Garg P. An Unusual Case of Auto-Immune Hemolytic Anemia. Indian Pediatr 2021; 58:992-993. [PMID: 34636332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Padma Garg
- Department of Pediatric Critical Care, University of Mississippi Medical Center, Jackson, MS, USA.
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Bogdał A, Badeński A, Pac M, Wójcicka A, Badeńska M, Didyk A, Trembecka-Dubel E, Dąbrowska-Leonik N, Walaszczyk M, Matysiak N, Morawiec-Knysak A, Szczepański T, Szczepańska M. Atypical Hemolytic Uremic Syndrome (aHUS) and Adenosine Deaminase (ADA)-Deficient Severe Combined Immunodeficiency (SCID)-Two Diseases That Exacerbate Each Other: Case Report. Int J Mol Sci 2021; 22:ijms22179479. [PMID: 34502390 PMCID: PMC8430959 DOI: 10.3390/ijms22179479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Hemolytic uremic syndrome (HUS) is defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Atypical HUS (aHUS), distinguished by its etiology, is caused by uncontrolled overactivation of the alternative complement pathway. The correct diagnosis of aHUS is complex and involves various gene mutations. Severe combined immunodeficiency (SCID), characterized by severe T-cell lymphocytopenia and a lack of antigen-specific T-cell and B-cell immune responses, is of seldom occurrence. In 10–15% of pediatric patients, SCID is caused by adenosine deaminase (ADA) deficiency. The authors describe the case of a boy who suffered from both aHUS and ADA-deficient SCID. At the age of 9 months, the patient presented acute kidney injury with anuria and coagulopathy. The diagnosis of aHUS was established on the basis of alternative complement pathway deregulation and disease-associated gene mutations. Further examination revealed immune system failure and, at the age of 13 months, the ADA deficiency was confirmed by genetic tests and the boy was diagnosed with ADA-SCID. ADA SCID has recently been described as a possible triggering factor of aHUS development and progression. However, more research is required in this field. Nevertheless, it is crucial in clinical practice to be aware of these two co-existing life-threatening diseases.
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Affiliation(s)
- Anna Bogdał
- District Hospital in Zawiercie, ul. Miodowa 14, 42-400 Zawiercie, Poland;
| | - Andrzej Badeński
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland; (A.B.); (M.B.)
| | - Małgorzata Pac
- Department of Immunology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.P.); (N.D.-L.)
| | | | - Marta Badeńska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland; (A.B.); (M.B.)
| | - Agnieszka Didyk
- Department of Pediatric Nephrology with Dialysis Division for Children, Public Clinical Hospital No. 1 in Zabrze, 41-800 Zabrze, Poland; (A.D.); (E.T.-D.); (A.M.-K.)
| | - Elżbieta Trembecka-Dubel
- Department of Pediatric Nephrology with Dialysis Division for Children, Public Clinical Hospital No. 1 in Zabrze, 41-800 Zabrze, Poland; (A.D.); (E.T.-D.); (A.M.-K.)
| | - Nel Dąbrowska-Leonik
- Department of Immunology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.P.); (N.D.-L.)
| | - Małgorzata Walaszczyk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland;
| | - Natalia Matysiak
- Department of Histology and Cell Pathology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland;
| | - Aurelia Morawiec-Knysak
- Department of Pediatric Nephrology with Dialysis Division for Children, Public Clinical Hospital No. 1 in Zabrze, 41-800 Zabrze, Poland; (A.D.); (E.T.-D.); (A.M.-K.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice ul. 3 Maja 13/15, 41-800 Zabrze, Poland;
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland; (A.B.); (M.B.)
- Correspondence: ; Tel.: +48-32-3704305; Fax: +48-32-3704292
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Pirrone I, Farruggia P, Cacciatore F, Giambona A, Guarina A, Marcello AP, Mosa C, Scalzo S, D'Angelo P. Rasburicase-induced Methemoglobinemia: A Case Report and Literature Review. J Pediatr Hematol Oncol 2021; 43:e886-e890. [PMID: 33122582 DOI: 10.1097/mph.0000000000001979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022]
Abstract
Rasburicase is a recombinant urate oxidase enzyme indicated for tumor lysis syndrome, a potential life-threatening oncologic emergency that occurs most commonly during initial chemotherapy for hematological malignancies. As a result of the defects in the physiological antioxidant pathway, erythrocytes of patients with glucose-6-phosphate dehydrogenase deficiency are not protected against the oxidizing stress exerted by hydrogen peroxide generated with the administration of rasburicase. The authors report a 14-year-old patient, diagnosed with T-cell acute lymphoblastic leukemia, who developed methemoglobinemia and hemolytic anemia with low oxygen saturation after starting steroids, hyperhydratation, and rasburicase administration. The complications resolved with supportive therapy only.
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Affiliation(s)
- Ilaria Pirrone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Pediatric Postgraduate School, University of Palermo
| | - Piero Farruggia
- Pediatric Hematology and Oncology Unit, Pediatric Department, ARNAS Civico, Di Cristina and Benfratelli Hospitals
| | - Francesca Cacciatore
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Pediatric Postgraduate School, University of Palermo
| | - Antonino Giambona
- Laboratory for Molecular Diagnosis of Rare Diseases, Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Villa Sofia-Cervello Hospital, Palermo
| | - Angela Guarina
- Pediatric Hematology and Oncology Unit, Pediatric Department, ARNAS Civico, Di Cristina and Benfratelli Hospitals
| | - Anna Paola Marcello
- Oncoematology Unit, Physiopathology of Anemia Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clara Mosa
- Pediatric Hematology and Oncology Unit, Pediatric Department, ARNAS Civico, Di Cristina and Benfratelli Hospitals
| | - Simona Scalzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Pediatric Postgraduate School, University of Palermo
| | - Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, Pediatric Department, ARNAS Civico, Di Cristina and Benfratelli Hospitals
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Covarelli C, Brugnano R, Pasquino S, Buoncristiani E, Del Sordo R, Sidoni A. [Relevance of an accurate microscopic examination of urinary sediment in a patient after mitral valve surgery]. G Ital Nefrol 2021; 38:38-03-2021-06. [PMID: 34169694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hemoglobinuria, clinically revealing as gross hematuria associated with anemia, increased hemolysis indices, acute kidney injury (AKI), can all be caused by mechanical intravascular hemolysis following mitral valve surgery. It can result from factors related to the surgical procedure or acquired later, such as paravalvular leak (PL), whose definite diagnosis is based on transesophageal echocardiography. We report the case of a patient who experienced macrohematuria and AKI, initially attributed to acute glomerulonephritis, two months after mitral valve surgery. Careful microscopic examination of the urinary sediment was a diriment diagnostic tool to differentiate acute renal failure caused by hemoglobinuria from hematuria in the course of acute glomerulonephritis, directing clinicians to investigate post-operative valvular dysfunction. From the literature review we can deduce that, notwithstanding new technologies in cardiac surgery, this rare form of AKI from intravascular hemolysis requires immediate nephrological attention and that the use of microscopic urinary sediment is decisive.
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Affiliation(s)
- Carla Covarelli
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Rachele Brugnano
- Specialista in Nefrologia, membro della Società Italiana di Nefrologia, Perugia, Italy
| | - Stefano Pasquino
- S.C. di Cardiochirurgia, Ospedale Santa Maria della Misericordia Perugia, Italy
| | | | - Rachele Del Sordo
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Angelo Sidoni
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
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39
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Kathiravelu Z, Thambiah SC, Mat Salleh MJ, Samsudin IN. Markedly raised haemolysis index with upper limit of normal serum potassium levels. Malays J Pathol 2021; 43:101-107. [PMID: 33903313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Haemolytic specimens are a frequent occurrence in clinical laboratories, and they interfere with the analysis of many tests. CASE REPORT We describe here an unusual case of leptospirosis complicated by haemolytic anaemia in a 70-year-old man with established kidney failure. He presented with an abrupt onset of shortness of breath, flushing and erythematous rash after completing haemodialysis. The patient's biochemistry test samples were however rejected twice as they were grossly haemolysed. The integrated auto-verification alert system implemented in the hospital's laboratory information system alerted the staff of the possibility of in vivo haemolysis. DISCUSSION The auto-verification alert system effectively distinguishes between in vitro and in vivo haemolysis and as such can be utilised as a diagnostic aid in patients with suspected intravascular haemolysis.
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Affiliation(s)
- Z Kathiravelu
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Departments of Pathology, Selangor, Malaysia
| | - S C Thambiah
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Departments of Pathology, Selangor, Malaysia.
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Malhotra R, Namasivayam M, Ghoshhajra BB, Passeri JJ, Hoenig PA, Stone JR. Case 36-2020: A 72-Year-Old Woman with Dark Urine and Weakness. N Engl J Med 2020; 383:2066-2076. [PMID: 33207098 DOI: 10.1056/nejmcpc2027077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rajeev Malhotra
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
| | - Mayooran Namasivayam
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
| | - Brian B Ghoshhajra
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
| | - Jonathan J Passeri
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
| | - Peter A Hoenig
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
| | - James R Stone
- From the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.M., M.N., J.J.P.), Radiology (B.B.G.), and Pathology (J.R.S.), Harvard Medical School - both in Boston, and the Department of Internal Medicine, Emerson Hospital, Concord, MA (P.A.H.)
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41
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Maquet J, Derumeaux H, Lapeyre-Mestre M, Sailler L, Moulis G. Validation of hemolytic anemia discharge diagnosis codes in the French hospital database. Eur J Intern Med 2020; 79:136-138. [PMID: 32340778 DOI: 10.1016/j.ejim.2020.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Julien Maquet
- Service de Médecine Interne, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; CIC 1436, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France.
| | - Hélène Derumeaux
- Département d'information médicale, Hôtel Dieu, 2 rue Viguerie, CHU de Toulouse, 31059 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- CIC 1436, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 37 allées Jules Guesde, 31000 Toulouse, France; UMR 1027 INSERM-Université de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
| | - Laurent Sailler
- Service de Médecine Interne, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; CIC 1436, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; UMR 1027 INSERM-Université de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; CIC 1436, CHU de Toulouse, hôpital Purpan, place du Dr Baylac, 31059 Toulouse, France; UMR 1027 INSERM-Université de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
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Moreno-Fernández MV, Núñez-Ochoa L, Lima-Melo A. Pathology in Practice. J Am Vet Med Assoc 2020; 254:931-933. [PMID: 30938619 DOI: 10.2460/javma.254.8.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Caré W, Mérat B, Foissaud V. [Severe hemolysis in a patient with prosthetic heart valve]. Rev Prat 2020; 70:184. [PMID: 32877137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Weniko Caré
- Service de médecine interne, hôpital d'instruction des armées Percy, Clamart, France
| | - Benoît Mérat
- Service de cardiologie et médecine aéronautique, hôpital d'instruction des armées Percy, Clamart, France
| | - Vincent Foissaud
- Laboratoire de biologie médicale, hôpital d'instruction des armées Percy, Clamart, France
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Poloni JAT, Hickmann FH. AKI in a Patient with Hemolytic Anemia. Kidney360 2020; 1:72-73. [PMID: 35372852 PMCID: PMC8808491 DOI: 10.34067/kid.0000082019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- José Antonio Tesser Poloni
- Health School, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
- Controllab, Rio de Janeiro, Brazil; and
| | - Fernanda Hermes Hickmann
- Carlos Franco Voegeli Clinical Analysis Laboratory, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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45
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Bhagra A, Mathew HA. Methylene blue induced haemolytic anaemia. J Assoc Physicians India 2020; 68:103. [PMID: 31979956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A Bhagra
- Vydehi institute of medical sciences and research centre, Bangalore
| | - H A Mathew
- Vydehi institute of medical sciences and research centre, Bangalore
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Kotera T, Itani K, Uchiyama H, Takemoto T, Ooyama K, Hirata K, Imashuku S, Nakajima S. A Rare Combination of Gastric Mucosa-associated Lymphoid Tissue Lymphoma, Autoimmune Gastritis, Thyroiditis, Hemolysis, and Systemic Lupus Erythematosus. Intern Med 2020; 59:61-65. [PMID: 31902909 PMCID: PMC6995723 DOI: 10.2169/internalmedicine.3191-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We herein report a case with the rare combination of mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) of the stomach, autoimmune gastritis (AIG), autoimmune thyroiditis, autoimmune hemolytic anemia (AIHA), and systemic lupus erythematosus. A 68-year-old woman was diagnosed with gastric MALT lymphoma associated with Helicobacter pylori (H. pylori) infection and AIG. Complete remission of the MALT lymphoma was achieved by H. pylori eradication and radiotherapy. Three years after the diagnosis of MALT lymphoma, the patient developed AIHA and anti-nuclear and anti-Smith autoantibody-positive lupus serositis, which were successfully managed with prednisolone administration.
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MESH Headings
- Anemia, Hemolytic/complications
- Anemia, Hemolytic/diagnosis
- Autoimmune Diseases
- Biopsy
- Endoscopy, Gastrointestinal
- Female
- Gastric Mucosa/pathology
- Gastritis/complications
- Gastritis/diagnosis
- Gastritis/immunology
- Humans
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Middle Aged
- Radiography, Thoracic
- Thyroiditis/complications
- Thyroiditis/diagnosis
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Affiliation(s)
- Tohru Kotera
- Department of Medical Examination, Uji-Tokushukai Medical Center, Japan
| | - Katsuhiko Itani
- Department of Internal Medicine, Uji-Tokushukai Medical Center, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | - Takahiro Takemoto
- Department of Gastroenterology, Uji-Tokushukai Medical Center, Japan
| | - Kazue Ooyama
- Department of Internal Medicine, Uji-Tokushukai Medical Center, Japan
| | - Kuniaki Hirata
- Department of Gastroenterology, Uji-Tokushukai Medical Center, Japan
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47
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Azzam M, Attalla S. Serum Folate Levels in Patients with Chronic Hemolytic Anemia on Regular Folic Acid Supplementation Before and After Dose Modification. Indian Pediatr 2019; 56:845-848. [PMID: 31724541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE In light of the recommendation of folic acid supplementation in chronic hemolytic anemia, with possible supratherapeutic dosing and associated side effects, we performed this study to investigate serum folate levels in children with chronic hemolytic anemia. METHODS Phase 1 was a cross-sectional study of 134 patients in the Pediatric Hematology service, documenting daily dosage and performing serum folate levels. In phase 2, we reduced the dose to 1 mg for 148 patients and repeated the testing after six months. RESULTS We found very high serum folate levels with Phase 1, with 93.2% above the upper level of normal. In Phase 2, values remained high with 42.5% above the acceptable upper limit. CONCLUSION Doses of folic acid given to sickle cell and thalassemia patients exceed their actual needs. This should be re-evaluated to strike a balance between benefit and harm, with close monitoring of serum folate levels.
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Affiliation(s)
- Mona Azzam
- Pediatric Department, Faculty of Medicine, Suez Canal University, Egypt. Correspondence to: Dr Mona Azzam, Pediatric Department, Faculty of Medicine, Suez Canal University, Egypt.
| | - Samy Attalla
- Medical laboratory Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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48
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Delmotte V, Foidart P, De VA, Lejeune M, Delwaide J. [Diagnosis of anemia associated with alcoholic cirrhosis]. Rev Med Liege 2019; 74:527-534. [PMID: 31609556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report here the case of a 62-year-old patient with Child-Pugh stage C ethylic cirrhosis associated with severe macrocytic anaemia, refractory to iterative transfusions and withdrawal. After a haemorrhagic, deficiency-related, or sideroblastic etiology was ruled out, haemolytic anaemia was suspected. A blood smear allowed diagnosis of haemolytic anaemia with acanthocytes. This offers the opportunity to discuss anaemia in patients with alcoholic cirrhosis, a frequent complication spanning a broad severity range and having the potential to be life-threatening. Its origin can be multifactorial : acute haemorrhage, dilution, haemolysis (here due to acanthocytosis), marrow insufficiency caused by direct alcohol toxicity, malnutrition, iron deficiency, vitamin B9 or B12 deficiency, chronic inflammation, splenic sequestration induced by portal hypertension...
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Affiliation(s)
- V Delmotte
- Service de Médecine Interne, CHU Liège, Belgique
| | - P Foidart
- Service d'Oncologie clinique, CHU Liège, Belgique
| | - Voeght A De
- Service d'Hématologie clinique, CHU Liège, Belgique
| | - M Lejeune
- Service d'Hématologie clinique, CHU Liège, Belgique
| | - J Delwaide
- Service de Gastro-Entérologie et Hépatologie, CHU Liège, Belgique
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49
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Abstract
BACKGROUND Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. METHODS We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. RESULTS Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. CONCLUSIONS Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.
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Vleeshouwers AT, den Haan NGJ, Broen KCJ, van de Wouw AJ. Recognizing the zebra: a carboplatin-induced haemolytic anaemia. Neth J Med 2019; 77:150-152. [PMID: 31502547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A T Vleeshouwers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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