Journal of hematology最新文献

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Iron Deficiency Anemia: An Overlooked Complication of Crohn’s Disease 缺铁性贫血:克罗恩病的一个被忽视的并发症
IF 1.2
Journal of hematology Pub Date : 2022-04-01 DOI: 10.14740/jh989
A. Abomhya, Waqqas Tai, Salman Ayaz, F. Khan, W. Saadedeen, O. Ajala, Rana Mohamed
{"title":"Iron Deficiency Anemia: An Overlooked Complication of Crohn’s Disease","authors":"A. Abomhya, Waqqas Tai, Salman Ayaz, F. Khan, W. Saadedeen, O. Ajala, Rana Mohamed","doi":"10.14740/jh989","DOIUrl":"https://doi.org/10.14740/jh989","url":null,"abstract":"Background There are few studies to evaluate the association between iron deficiency anemia (IDA) and Crohn’s disease (CD). We examined this association in a USA-based cohort of patients with CD. Methods We queried the Nationwide Readmission Databases 2018 using the International Classification of Disease, 10th Revision, and Clinical Modification (ICD-10-CM) codes to identify all adult patients admitted with a diagnosis of CD. Primary outcomes were the prevalence of IDA among patients with CD. Secondary outcomes included inpatient mortality, the length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Multivariate regression analysis was performed to study the impact of IDA on inpatient mortality and non-elective readmissions. Results Of the 72,076 patients discharged from an index hospitalization for CD, 8.1% had IDA. CD patients with IDA had increased length of stays in days (4, interquartile range (IQR): 2 - 6 vs. 3, IQR: 2 - 5; P < 0.001), increased median total charges ($35,160, IQR: $19,786 - $64,126 vs. $31,299, IQR: $17,226 - $59,561; P < 0.001), and were more common to require blood transfusion during hospitalization (13.6% vs. 3.4%, P < 0.001) compared to CD patients without IDA, respectively. IDA was independently associated with increased odds of all-cause 30-day non-elective readmission (odds ratio (OR): 1.254, 95% confidence interval (CI): 1.154 - 1.363, P < 0.001) and increased odds of all-cause 90-day non-elective readmission (OR: 1.396, 95% CI: 1.302 - 1.498, P < 0.001). Conclusions In a large nationwide cohort of patients hospitalized for CD, we observed a significant burden of IDA. Additionally, we found a significant association between IDA and worse hospitalization outcomes.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46893509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
An Unusual Case of Delayed Hemolytic Transfusion Reaction With Hyperhemolysis Syndrome Due to Anti-Jkb and Anti-Fya Alloantibodies 抗jkb和抗fya异体抗体引起的迟发性溶血性输血反应伴高溶血综合征1例
IF 1.2
Journal of hematology Pub Date : 2022-04-01 DOI: 10.14740/jh968
K. El Alaoui, F. Benghiat, M. Colard
{"title":"An Unusual Case of Delayed Hemolytic Transfusion Reaction With Hyperhemolysis Syndrome Due to Anti-Jkb and Anti-Fya Alloantibodies","authors":"K. El Alaoui, F. Benghiat, M. Colard","doi":"10.14740/jh968","DOIUrl":"https://doi.org/10.14740/jh968","url":null,"abstract":"Delayed hemolytic transfusion reaction (DHTR) is a complication appearing a few days to weeks due to alloimmunization following packed red blood cells (RBCs) transfusion, a pregnancy, or transplantation. Hyperhemolysis syndrome (HS) is a severe form of DHTR defined by a drop of hemoglobin to a level lower than before the transfusion, reflecting a destruction of the patient’s own RBCs not presenting the targeted antigen as well as the transfused RBCs. Usually seen in sickle cell disease (SCD) patients, HS remains very rare in patients without a hematologic disorder. We report the case of an 82-year-old Caucasian woman who presented with a DHTR with HS after being transfused packed RBC twice in the context of rectal bleeding. The patient was not known for any hemoglobinopathy and did not have a history of massive transfusions nor multiple pregnancies putting her at risk of alloimmunization. Our patient developed anti-C, anti-Fya and anti-Jkb antibodies, known to be harmful antibodies. First line of treatment after avoidance of further transfusions is intravenous immunoglobulins for 3 to 5 days and high-dose corticosteroids. Exceptional in the non-SCD population, this complication should be recalled by clinicians as it can be fatal if not treated appropriately. We performed a review of the literature using the words “delayed hemolytic transfusion reaction” and “hyperhemolysis syndrome” for similar cases. Finally, we describe how to diagnose, manage, and prevent this potentially fatal complication, which is still underrecognized even within the SCD population.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45178659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cyclical Thrombocytopenia Synchronized With the Patient's Menstrual Cycle Treated With Danazol. 达那唑治疗周期性血小板减少症与患者月经周期同步。
IF 1.2
Journal of hematology Pub Date : 2022-04-01 DOI: 10.14740/jh964
Sasmith R Menakuru, Adelina Priscu, Vijaypal Dhillon, Ahmed Salih
{"title":"Cyclical Thrombocytopenia Synchronized With the Patient's Menstrual Cycle Treated With Danazol.","authors":"Sasmith R Menakuru,&nbsp;Adelina Priscu,&nbsp;Vijaypal Dhillon,&nbsp;Ahmed Salih","doi":"10.14740/jh964","DOIUrl":"https://doi.org/10.14740/jh964","url":null,"abstract":"<p><p>Cyclical thrombocytopenia (CTP) is a very rare condition and often misdiagnosed as immune thrombocytopenia (ITP) due to similar features existing between the two. When evaluating a patient for the possible diagnosis of ITP, CTP must be high on the differential diagnosis. The main difference between the two conditions is that CTP is usually unresponsive to the treatment given to ITP and will ultimately display a cyclical nature with periods of low, normal and elevated platelets. As of date, there are only 70 cases in the literature. However, this number may be misrepresented due to the difficulty in diagnosis. The authors report a case of a 36-year-old woman who was misdiagnosed with ITP and underwent unnecessary treatment with corticosteroids, rituximab, intravenous immunoglobulins, and a splenectomy. A diagnosis of CTP was made after extensive review and the authors aim to bring awareness of this uncommon condition.</p>","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/5d/jh-11-062.PMC9076142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10598666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Case of Isolated Myeloid Sarcoma Associated With Germline EGFR T790M Variant: The Importance of Recognizing Potential Germline Variants on Somatic Tumor Sequencing Panels 一例与种系EGFR T790M变异体相关的孤立性髓性肉瘤:在体细胞肿瘤测序板上识别潜在种系变异体的重要性
IF 1.2
Journal of hematology Pub Date : 2022-04-01 DOI: 10.14740/jh983
Margaret Walker, Matthew Folstad, Kelcy Smith-Simmer, Erica F Reinig, Kalyan Nadiminti, Lauren Lovrien, J. Churpek, L. Banaszak
{"title":"A Case of Isolated Myeloid Sarcoma Associated With Germline EGFR T790M Variant: The Importance of Recognizing Potential Germline Variants on Somatic Tumor Sequencing Panels","authors":"Margaret Walker, Matthew Folstad, Kelcy Smith-Simmer, Erica F Reinig, Kalyan Nadiminti, Lauren Lovrien, J. Churpek, L. Banaszak","doi":"10.14740/jh983","DOIUrl":"https://doi.org/10.14740/jh983","url":null,"abstract":"Isolated myeloid sarcoma is an uncommon subtype of acute myeloid leukemia associated with variable prognosis. We present the case of a previously healthy 30-year-old man presenting with chest pain and weight loss who was found to have a large mediastinal mass. Biopsy of the mass was consistent with isolated myeloid sarcoma. A somatic tumor sequencing panel revealed an EGFR T790M variant, which was later confirmed to be of germline origin. Germline EGFR T790M variants are associated with a hereditary predisposition to lung cancer, though myeloid malignancies have not yet been described. To our knowledge, this is the first reported case of myeloid sarcoma in a patient with an underlying germline EGFR T790M mutation. As somatic tumor sequencing panels become more commonplace, it is important to recognize potential germline variants in order to facilitate appropriate referral for genetic counseling, perform confirmatory genetic testing, and to develop a personalized treatment and surveillance plan for patients and their families.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Site-Specific Survival of Extra Nodal Diffuse Large B-Cell Lymphoma and Comparison With Gastrointestinal Diffuse Large B-Cell Lymphoma 结节外弥漫性大B细胞淋巴瘤的部位特异性生存率及与胃肠道弥漫性大B-细胞淋巴瘤的比较
IF 1.2
Journal of hematology Pub Date : 2022-04-01 DOI: 10.14740/jh984
Varsha Gupta, V. Singh, R. Bajwa, T. Meghal, Shuvendu Sen, David Greenberg, M. Anne, M. Levitt
{"title":"Site-Specific Survival of Extra Nodal Diffuse Large B-Cell Lymphoma and Comparison With Gastrointestinal Diffuse Large B-Cell Lymphoma","authors":"Varsha Gupta, V. Singh, R. Bajwa, T. Meghal, Shuvendu Sen, David Greenberg, M. Anne, M. Levitt","doi":"10.14740/jh984","DOIUrl":"https://doi.org/10.14740/jh984","url":null,"abstract":"Background Diffuse large B-cell lymphoma (DLBCL) constitutes 30% of all non-Hodgkin’s lymphomas. It can present as a nodal disease or as an extra nodal disease. Based on the site of origin, extra nodal DLBCL (EN-DLBCL) may have a distinct clinical outcome. Apart from the site of origin, factors including demographics, stage, and presence of any other primary malignancy also affect the outcome. The purpose of our study was to characterize prognostically distinct groups based on the site of presentation of EN-DLBCL. Methods We used 18 registries in Surveillance, Epidemiology, and End Results database to identify the patients with EN-DLBCL for 2000 - 2015 with last follow-up till December 31, 2018. A total of 30,290 EN-DLBCL patients were selected and categorized based on 13 broad sites grouping. Demographic variables were summarized. We did overall survival analysis with univariate and multivariate Cox-proportional hazard modeling. Short-term survival trend was calculated as well. Results The percentage of EN-DLBCL of all DLBCLs is 34.48%. EN-DLBCL was comparatively seen more in males (54.94%) and non-Hispanic whites (71.52%). In terms of clinical characteristics, patients with EN-DLBCL were mostly diagnosed at age ≥ 60 years (66.11%), early stage (69.33%), and presentation as first primary cancer (81.89%). A higher risk of mortality was seen in non-Hispanic black (hazard ratio (HR) 1.36), with late age of onset (HR 2.69), late stage at presentation (HR 1.42), and with history of other malignancy (HR 1.29). Compared to the intestinal tract, the risk of overall mortality was higher in individuals with involvement of nervous system (HR 1.85), pancreas and hepatobiliary system (HR 1.22), and respiratory system (HR 1.18) and the best outcomes were seen in heart and mediastinal site (HR 0.58) of DLBCL. Conclusion Based upon our population-based study, we conclude that primary site of presentation of EN-DLBCL is an important prognostic factor with significant difference in survival based on histological and epidemiological characteristics.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48568225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Transmission of Human T-Lymphotropic Virus Type I to Donor-Origin T Cells During Allogeneic Hematopoietic Stem Cell Transplantation 异基因造血干细胞移植过程中人I型T淋巴细胞病毒向供体来源T细胞的传播
IF 1.2
Journal of hematology Pub Date : 2022-03-12 DOI: 10.14740/jh973
M. Hirosawa, D. Niino, J. Tsukada
{"title":"Transmission of Human T-Lymphotropic Virus Type I to Donor-Origin T Cells During Allogeneic Hematopoietic Stem Cell Transplantation","authors":"M. Hirosawa, D. Niino, J. Tsukada","doi":"10.14740/jh973","DOIUrl":"https://doi.org/10.14740/jh973","url":null,"abstract":"Human T-lymphotropic virus type I (HTLV-I) is a retrovirus that causes adult T-cell leukemia/lymphoma (ATLL), an aggressive CD4-positive mature T-cell malignancy with a dismal prognosis [1, 2]. In addition, the virus is associated with chronic inflammatory diseases such as HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP), arthritis, uveitis, dermatitis, and bronchioloalveolar disorders. It is estimated that HTLV-I infects 5 20 million individuals worldwide [3, 4]. HTLV-I is transmitted via breast feeding, sexual intercourse, needle sharing, and blood products containing cells. Organ transplantation has also been considered a rare route of HTLV-I transmission [5]. Here, we describe a case of HTLV-I transmission to T cells of an HTLV-I-negative donor through allogeneic hematopoietic stem cell transplantation (allo-HSCT). A 56-year-old man with a history of ATLL was referred to our hospital for dyspnea. Two years before the presentation, he underwent allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from an HTLV-I-negative female donor with a reduced intensity conditioning (RIC) regimen consisting of fludarabine, melphalan, and total body irradiation (4 Gy). T-cell depletion was carried out using thymoglobulin. At the time of transplantation, the patient had systemic lymphadenopathy due to refractory ATLL. After transplantation, the patient achieved a complete remission. The HTLV-I-negative donor had neither atypical lymphocytes in the peripheral blood (PB) nor lymphadenopathy. The seronegativity of anti-HTLV-I antibody was confirmed by chemiluminescence enzyme immunoassay. Serum immunoglobulin levels of the donor were within normal limits. When the patient was referred to our hospital with dyspnea, he was receiving tacrolimus therapy for chronic graft-vshost disease (GVHD). He immediately underwent a complete blood count, which revealed 11 × 109/L white blood cells with 17% of atypical lymphocytes. The morphologic feature of the atypical lymphocytes was pleomorphic with condensed chromatin and convoluted or lobulated nucleus (Fig. 1a). Flow cytometric analysis (FCM) revealed that the atypical lymphocytes were positive for CD3 (Fig. 1b), CD25 (Fig. 1b) and CD4, and negative for CD8. Furthermore, the atypical lymphocytes, unlike his pretransplant ATLL cells, expressed CD7 (Fig. 1c). An increased HTLV-I proviral load (PVL) of 397.2 copies/1,000 PB mononuclear cells (PBMCs) was detected. Although no hypercalcemia was observed, serum lactate dehydrogenase and soluble interleukin (IL)-2 receptor levels were elevated to 290 U/L (normal: 124 222 U/L) and 30,573 U/ mL (normal: 145 519 U/mL), respectively. Epstein-Barr virus (EBV) and cytomegalovirus were negative in real-time quantitative polymerase chain reaction. Computed tomography of the chest revealed a mediastinal tumor and pleural effusion (arrows: Fig. 1d). Tumor biopsy showed diffuse infiltration of medium to large, atypical cells with irregular nuclear contour","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49477872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Compound Heterozygous Factor VII Deficiency c.1025G>A p.(Arg342Gln) With Novel Missense Variant c.194C>G p.(Ala65Gly) 化合物杂合因子VII缺乏c.1025G>A.p.(Arg342Gln)与新的错义变体c.194C>G.p.(Ala65Gly)
IF 1.2
Journal of hematology Pub Date : 2022-02-01 DOI: 10.14740/jh943
C. Gallardo, L. Wong, C. L. L. Sum, L. Goh, K. Ong
{"title":"Compound Heterozygous Factor VII Deficiency c.1025G>A p.(Arg342Gln) With Novel Missense Variant c.194C>G p.(Ala65Gly)","authors":"C. Gallardo, L. Wong, C. L. L. Sum, L. Goh, K. Ong","doi":"10.14740/jh943","DOIUrl":"https://doi.org/10.14740/jh943","url":null,"abstract":"Factor VII (FVII) deficiency manifests as prolonged prothrombin time (PT) and reduced FVII activity. We report a case of an asymptomatic 60-year-old gentleman with discrepancies in PT and FVII coagulant activity levels (FVII:C) on three different thromboplastin reagents used. Further sequence analysis on genomic DNA showed double heterozygosity for c.1025G>A p.Arg342Gln and c.194C>G p.Ala65Gly in the F7 gene. To date, p.Ala65Gly in exon 2 of the F7 gene represents a novel variant in patients with FVII deficiency and is classified as likely pathogenic. Computational prediction tools support a deleterious effect on the gene. The genotype-phenotype association and the clinical significance of this exon 2 missense variant is proposed in this case report.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42194807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hematopoietic Stem Cell Transplantation Stabilizes Cerebral Vasculopathy in High-Risk Pediatric Sickle Cell Disease Patients: Evidence From a Referral Transplant Center 造血干细胞移植稳定高危儿童镰状细胞病患者的脑血管病:来自转诊移植中心的证据
IF 1.2
Journal of hematology Pub Date : 2022-02-01 DOI: 10.14740/jh949
Abdullah H. Al-Jefri, K. Siddiqui, Amira Al-Oraibi, A. Al-Seraihy, A. Al Ahmari, I. Ghemlas, Awatif Al Anazi, Hawazen Al Saedi, M. Ayas
{"title":"Hematopoietic Stem Cell Transplantation Stabilizes Cerebral Vasculopathy in High-Risk Pediatric Sickle Cell Disease Patients: Evidence From a Referral Transplant Center","authors":"Abdullah H. Al-Jefri, K. Siddiqui, Amira Al-Oraibi, A. Al-Seraihy, A. Al Ahmari, I. Ghemlas, Awatif Al Anazi, Hawazen Al Saedi, M. Ayas","doi":"10.14740/jh949","DOIUrl":"https://doi.org/10.14740/jh949","url":null,"abstract":"Background Severe sickle cell disease (SCD) can present with different vaso-occlusive manifestations with cerebral vasculopathy (CV) as one of the most serious complications. Hematopoietic stem cell transplant (HSCT) is the ultimate therapy for this complication. The aim of this study was to assess the outcome and impact of HSCT on severe SCD patients with CV complications. Methods Twenty-five consecutive transplants-naive pediatric SCD patients with CV complications underwent HSCT at our institution between 1993 and 2015, using bone marrow as stem cells source from fully match related donors were included. Neurologic evaluation was done both clinically and radiologically before transplantation and regularly following the HSCT. Results With a median follow-up of 52.2 ± 5.8 months, the cumulative probability of overall survival (OS) at 3 years was 92.0% and event-free survival (EFS) was 88%. Significant neurologic improvements were observed in most of the patients clinically. Different neurologic complications were assessed. The neurologic manifestations before and after HSCT were hemiparesis (11, 1), seizures (13, 8), focal neurologic deficit (4, 2), loss of conscious (2, 1) headache (6, 1), and psychological symptoms (5, 2). Post-HSCT radiological imaging was done in 15 patients, which showed stabilization of CV among all. Conclusions Allogeneic HSCT in patients with severe SCD presenting with CV complications including moyamoya vasculopathy showed favorable outcome with significant clinical neurologic improvement and stabilization of the disease. None of the patients with severe vasculopathy underwent neurological vascular by-pass surgery prior to HSCT.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49257441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination SARS-CoV-2现代mRNA疫苗接种后的严重再生障碍性贫血
IF 1.2
Journal of hematology Pub Date : 2022-02-01 DOI: 10.14740/jh954
S. Sridhara, R. Nair, M. Stanek
{"title":"Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination","authors":"S. Sridhara, R. Nair, M. Stanek","doi":"10.14740/jh954","DOIUrl":"https://doi.org/10.14740/jh954","url":null,"abstract":"A 60-year-old male patient presented to the emergency department with complaints of easy bruising and worsening epistaxis after receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Moderna mRNA vaccination. He had no personal or family history of hematological conditions. He had bruises in various stages involving the upper and lower extremities. Laboratory data revealed white blood cell count of 1.2 ×103/mm3, hemoglobin of 8.0 g/dL, platelet count of 1 ×103/mm3, immature platelet fraction of 0.7%, absolute neutrophil count of 0 ×103/µL, lymphocytes of 1.1 ×103/µL, neutrophils of 3% and lymphocytes of 93%. He had normal liver and renal function tests. Bone marrow biopsy confirmed very severe aplastic anemia with severely hypocellular bone marrow. His platelets continued to downtrend despite platelet transfusions and steroids. He was treated with immunosuppressive therapy with cyclosporine, anti-thymocyte globulin, eltrombopag and prednisone. The patient was discharged but was readmitted to the hospital secondary to recurrent neutropenic fever and pneumonia. He had high-grade vancomycin-resistant enterococcal infection and Clostridium difficile infection leading to septic shock and succumbing to cardiac arrest. This case demonstrates the possibility of very severe aplastic anemia following SARS-CoV-2 mRNA vaccination and clinicians need to be aware of this rare but serious side effect.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42143449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Ischemic Stroke and Bilateral Pulmonary Embolism in COVID-19: COVID-Associated Coagulopathy or Heparin-Induced Thrombocytopenia COVID-19缺血性卒中和双侧肺栓塞:COVID-19相关凝血功能障碍或肝素诱导的血小板减少症
IF 1.2
Journal of hematology Pub Date : 2022-02-01 DOI: 10.14740/jh956
S. Soliman, Medhat Ghaly
{"title":"Ischemic Stroke and Bilateral Pulmonary Embolism in COVID-19: COVID-Associated Coagulopathy or Heparin-Induced Thrombocytopenia","authors":"S. Soliman, Medhat Ghaly","doi":"10.14740/jh956","DOIUrl":"https://doi.org/10.14740/jh956","url":null,"abstract":"A main feature of coronavirus disease 2019 (COVID-19) pathogenesis is the high frequency of thrombosis, predominantly pulmonary embolism (PE). Anticoagulation therapy is a crucial part of the management. Heparin use for anticoagulation could increase the risk of heparin-induced thrombocytopenia (HIT), a potentially fatal complication that presents with thrombocytopenia with or without thrombosis. We present a 69-year-old unvaccinated female patient with severe COVID-19 pneumonia. Initial laboratory investigation was significant for thrombocytopenia and low D-dimer levels. She was initially started on enoxaparin followed by unfractionated heparin. On hospital day 8, she developed left facial droop and dysarthria and was found to have non-occlusive thrombus in proximal middle cerebral artery as well as bilateral pulmonary emboli. She received intravenous thrombolysis followed by heparin infusion. On day 13 of hospitalization, platelet count dropped from 120,000/mm3 to 43,000/mm3, raising suspicion of HIT. Heparin was stopped and fondaparinux was started. After 3 days, HIT antibody testing returned positive, then a positive serotonin release assay confirmed the diagnosis. On discharge, she was transitioned to apixaban to complete 3 months of anticoagulation for provoked PE. This case represents the diagnostic challenge of HIT in COVID-19 patients. Thrombocytopenia after heparin infusion should raise clinical suspicion of HIT, which allows appropriate discontinuation of heparin products and initiation of alternative anticoagulants to limit devastating complications. To our knowledge, this is the first case report of a COVID-19 patient presenting with venous thrombosis as well as arterial thrombotic event in the context of underlying HIT.","PeriodicalId":15964,"journal":{"name":"Journal of hematology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67236420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
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