Very Severe Aplastic Anemia Due to Doxycycline Therapy

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4794-4794
Author(s):  
Prabhsimranjot Singh ◽  
Ankur Sinha ◽  
Anisha Kamath ◽  
Sonali Malhotra ◽  
Abhinav B Chandra
Keyword(s):  
Bone Marrow ◽  
Family History ◽  
Aplastic Anemia ◽  
Skin Rash ◽  
Conflicts Of Interest ◽  
Severe Aplastic Anemia ◽  
Packed Red Blood Cells ◽  
First Case ◽  
History Of ◽  
Cellular Bone

Abstract Very severe aplastic anemia due to doxycycline therapy A 42 y/o male presented to the emergency department with 3 weeks history of fatigue and epistaxis. On initial blood work he was found to have pancytopenia with hemoglobin of 4.7g/dl, platelet count of 4,000 and absolute neutrophil count of 160. He has no significant family history. His past medical history was only significant for a skin rash, which was biopsied 3 months ago and reported to be follicular dermatitis. The only home medication he has taking was doxycycline 100mg twice a day for the past few weeks before the current hospital admission. He was transfused with packed red blood cells and platelets to maintain hemodynamic stability. His bone marrow biopsy was reported to be hypocellular (<5% cellularity) with normal morphological features (see figure 1). Paroxysmal nocturnal hemoglobinuria was ruled out by flow cytometry. Workup including HIV, EBV, Hepatitis B and C and parvovirus serology was reported to be negative. His history of long-term Doxycycline use as well as no family history of any similar disorder, it is plausible that doxycycline could have caused his aplastic anemia. In congruence with the above mentioned findings, he is diagnosed with very severe aplastic anemia and is planned to be started on immunosuppressive therapy with equine anti-thymocyte globulin and cyclosporine along with consultation for allogeneic transplant. Aplastic anemia is a remarkably rare but serious adverse effect of drug therapy like antimicrobials. We report this as the first case, to the best of our knowledge based on the literature review, of possible doxycycline induced severe aplastic anemia. Our patient had history of skin rash for which he was taking doxycycline for few weeks before he presented with pancytopenia. Acquired aplastic anemia is a rare hematological disorder presenting with pancytopenia and a predominantly empty marrow. It is a fatal disease and irrespective of the etiology, without treatment, patients usually succumb due to infection and bleeding. Cases have been reported with tetracycline as a causative agent of aplastic anemia. We hypothesize doxycycline to be the possible etiology of severe aplastic anemia in this patient. Practitioners need to be aware of this rare but fatal complication of this widely used antibiotic. Figure 1. Hypo-cellular Bone Marrow Figure 1. Hypo-cellular Bone Marrow Disclosures No relevant conflicts of interest to declare.

Antithymocyte Rabbit Globulin Is Safe and Effective in Children with Severe Aplastic Anemia Report Polish Pediatric Hematology Group (Warszawa, Krakow, Wroclaw, Bydgoszcz, Poznan, Lodz, Bialystok, Szczecin, Gdansk).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4220-4220
Author(s):  
Katarzyna Pawelec ◽  
Michal Matysiak ◽  
Malgorzata Salamonowicz ◽  
Walentyna Balwierz ◽  
Ewa Zaleska-Czepko ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Conflicts Of Interest ◽  
Working Party ◽  
Bone Marrow Examination ◽  
Observation Time ◽  
Response To Treatment ◽  
Severe Aplastic Anemia ◽  
Pediatric Hematology

Abstract Abstract 4220 Bone marrow transplantation (BMT) is a therapy of choice in children with severe aplastic anemia (SAA), but it is possible only in about 15-20% patients who have family donors, so the majority of them received the immunosuppressive therapy (IST). We want to present the results of IST obtained in 116 children treated between 1993-2008 years at 11 pediatric hematology centers of the Polish Pediatric Hematology Group (PPHG),, 55 patients (22 girls and 33 boys aged 0,6-17,5 years) received antithymocyte rabbit globulin (ATG) as a first course of therapy. ATG was administered according to PPHG and Working Party SAA Group of EBMT protocol: ATG 3.75mg/kg iv for 5 days, cyclosporin A (CSA) 5mg/kg orally from day 1 to day 180 and granulocyte-stimulating factor during deep neutropenia. Remission of the disease was assessed on days 112, 180 and 360 from start of therapy on the basis of blood and bone marrow examination. The results on 112 and 180 were similar. The remission was achieved in 28 of 55 children (51%), complete remission (CR) in 5 children (9%), and partial remission (PR) in 23 children (42%). On day 360 remission was obtained in 30 of 55 patients (42 %), CR in 10 children (18%) and PR in 20 children (36%) There was no response to treatment (NR) in 25 patients (45%). In the group of 55 patients, 15 died (27%). 5 of them died early (day 52 and day 72 of therapy) due to septicemia and central nervous system (CNS) hemorrhage. The other 10 died late (day 99 and day 360 of therapy) due to CNS hemorrhage. Observation time of patients ranged from 1 to 14 years. During this time we noted four relapse. PNH was observed in one patient. The probability of 14 year survival in our group of patients treated initially with rabbit ATG is 72,7%. The results in the last follow up (Jun 2009) are better then earlier. We observed CR in 23/55 children (42%), PR in 10/55 (18%), NR 18/55 (33%). o information about 4 patients. We conclude that initial treatment with rabbit ATG is safe and effective in children. Further studies are needed, to assess long-term effectiveness of rabbit ATG in IST. Disclosures: No relevant conflicts of interest to declare.

Recombinant Human Thrombopoietin Promotes The Recovery Of Megakaryocyte Lineage In Patients With Severe Aplastic Anemia Receiving Immunosuppressive Therapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2437-2437
Author(s):  
Zonghong Shao ◽  
Qi'e Dong ◽  
Rong Fu
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Platelet Transfusion ◽  
Conflicts Of Interest ◽  
Severe Aplastic Anemia ◽  
Hematologic Response ◽  
Patient Will ◽  
Red Cell Transfusion ◽  
Recombinant Human Thrombopoietin

Abstract Objective To assess the effectiveness of recombinant human thrombopoietin (rhTPO) in severe aplastic anemia (SAA) patients receiving immunosuppressive therapy (IST). Methods Eighty SAA patients receiving IST during a period from January 2007 to December 2011 were included in this retrospective analysis. Thirty-two subjects also received rhTPO treatment (15,000 U, three times a week, subcutaneously). The remaining 48 patients did not receive rhTPO treatment. The choice of using (or not using) rhTPO was based on physician discretion, and more importantly, patient will (partly based on financial capability to afford the medication). rhTPO was discontinued when platelet count returned to normal range. Hematologic response, bone marrow recovery, transfusion interval (platelet or red-cells), and the time to transfusion-free status were compared. Result At 6th months after the treatment, hematologic response along at least one lineage was achieved in 65.6% of the subjects receiving rhTPO vs. 41.7% in those who did not receive rhTPO (p=0.04). Response rate of megakaryocyte and erythroid lineage at 3rd months was also higher in subjects receiving rhTPO than in those who did not (43.8% vs. 10.4%, p=0.001; 50.0% vs. 20.8%, p=0.006). The mean number of megakaryocyte per bone marrow slide was higher in subjects receiving rhTPO than those who did not (9.7±3.1 vs. 2.6±4.2, p=0.002) after three months. The percentage of nucleated erythroid cells in bone marrow was also higher in subjects receiving rhTPO after three months (22.2±13.2% vs. 13.6±13.9% in those who did not receive rhTPO; p=0.007). The percentage of reticulocytes in peripheral blood was higher in subjects receiving rhTPO (1.9±1.4% vs. 0.7±0.4% in those who did not receive rhTPO; p=0.001) after three months. Myeloid percentage in bone marrow did not differ at any time points (3, 6, or 9 months). The need for platelet transfusion was lower in subjects receiving rhTPO (transfusion interval: 13.8±14.3 vs. 6.9±5.2 and 26.3±28.9 vs. 15.7±13.1 days in those who did not receive rhTPO during the first three and six months, respectively; P=0.004, P=0.03). The need for red cell transfusion was also lower in subjects receiving rhTPO (interval: 32.5±22.0 vs. 11.9±7.2 days and 50.4±27.9 vs. 23.9±20.1 days during the first three and six months, respectively; p=0.001 P=0.009). Time to independence from platelet transfusion was significantly shorter in subjects receiving rhTPO (99.9±49.9 vs. 156.3±14.5 days in those who did not receive rhTPO; p=0.01). Conclusion rhTPO improves hematologic response and promotes bone marrow recovery in SAA patients receiving IST. Disclosures: No relevant conflicts of interest to declare.

A Retrospective Evaluation of the Effects of Severe Aplastic Anemia Treatment in Children with Horse and Rabbit ATG.Polish Pediatric Hematology Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4375-4375 ◽  
Author(s):  
Katarzyna Pawelec ◽  
Michal Matysiak ◽  
Malgorzata Salamonowicz ◽  
Jerzy Kowalczyk ◽  
Walentyna Balwierz ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Severe Aplastic Anemia ◽  
Retrospective Evaluation ◽  
Pediatric Hematology ◽  
Probability Of Survival ◽  
Anemia Treatment

Abstract Abstract 4375 Antithymocyte horse globulin (hATG) or rabbit (rATG) is used to treat children with severe aplastic anemia (SAA) in the absence of a compatible bone marrow family donor’s. We presenting (viewing) retrospective evaluation of the effects of SAA therapy using hATG and rATG. 49 children (20 girls and 29 boys, aged 1.2–17) were treated between 1993 and 2000 - hATG (15mg/kg/day for 5 days with cyclosporine 5mg/kg/day for 12–24 mths). On day 180 day of treatment there was a complete response (CR) in 22 of 49 children (44.5%) and a partial response (PR) in 12 children (24.4%). 34 of 49 children (69,4%) responded to treatment. There was no remission (NR) in 15 of 49 children (30.6%). In the whole group there were 7 deaths during the first 6 months. There were no relapses within 5 years of observation. The 5-year probability of survival in this group was 84%. 55 children (22 girls and 33 boys, aged 3,5–17,7 years) were treated in the years 1996–2009 using rATG (3.75 mg/kg/day for 5 days and cyclosporine 5mg/kg/day for 12–24 mths). On day 180 of treatment 5 patients (9%) achieved a CR, 23 children (41.8%) had a PR. 28 of 55 children (50.9%) responded to treatment. NR was found in 27 children (49%).In the rATG group 15 deaths (27%) were recorded, 4 patients (7%) had relapses. In one child paroxysmal nocturnal hemoglobinuria was noted.The 5-year survival in the rATG.group was 63.54%. Our results show the greater effectiveness of treatment with horse globulin than rabbit globulin in terms of hematological response and overall survival. Disclosures: No relevant conflicts of interest to declare.

scholarly journals SAT-335 New Onset Adult Idiopathic Primary Hypoparathyroidism Concomitant with Severe Aplastic Anemia

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sophia Galustian ◽  
Suguni Loku Galappaththy ◽  
Kavita Jadhav ◽  
Peminda K Cabandugama
Keyword(s):  
Family History ◽  
Aplastic Anemia ◽  
Lower Limit ◽  
Serum Calcium ◽  
Calcium Level ◽  
Neck Surgery ◽  
Severe Aplastic Anemia ◽  
Unknown Etiology ◽  
History Of ◽  
Lower Limit Of Normal

Abstract Introduction: Primary hypoparathyroidism is a relatively rare cause of hypocalcemia with cases of primary hypoparathyroidism in the US estimated at 24–37 per 100,000 with 75% being due to neck surgery and 25% due to non-surgical causes. The clinical presentation depends on the acuity of development of hypocalcemia and the absolute level of serum calcium. Here is a case of severe hypocalcemia secondary to hypoparathyroidism of unknown etiology followed by the development of severe aplastic anemia.Case report: A 60-year-old Caucasian male presented to our ED with fatigue, tingling, numbness in extremities and was found to have severe hypocalcemia at 6.8 mg/dl and decreased PTH at 11 pg/mL. Calcium levels 8 months prior to presentation were normal. No history of neck surgery, radiation exposure or family history of autoimmune disorders. Initial workup included creatinine, magnesium and TSH were normal. Autoimmune panel (including PTH Abs and CaSR Abs), HIV test, hepatitis panel, serum protein electrophoresis were also negative. Infiltrative causes of hypoparathyroidism including hemochromatosis, malignancy and granulomatous diseases like sarcoidosis were ruled out with tissue sampling and lab workup. Sestamibi scan obtained showed no parathyroid activity in all four glands. Patient was initially treated with IV calcium to improve serum calcium to more than 7.5mg/L and then switched to oral calcium carbonate 500mg TID and calcitriol 0.5mcg BID until the calcium level was brought up to the lower limit of normal. Patient was seen in follow up and was doing well without any adverse effects. Consequently, the patient developed severe aplastic anemia which was treated with steroids and interestingly, has caused a gradual but consistent increase in PTH levels.Discussion: Idiopathic hypoparathyroidism (IHP) is a rare condition with an incidence of 0.02%. IHP can occur sporadically or as part of a familial condition with autosomal dominant, recessive and X-linked recessive patterns. Certain autosomal forms of hypoparathyroidism have mutations in the PTH gene and Calcium-Sensing Receptor (CaSR) gene. The challenging nature of this case is due to the subacute nature of the patient’s presentation along with the lack of a definitive etiology. The patient’s negative family history and older age makes genetic causes less likely, and Abs against PTH and CaSr were also negative. The patient’s diagnosis of severe aplastic anemia has made the case more fascinating, especially since its management with steroids has causes an improvement in the patient’s PTH status. Regardless of etiology, primary hypoparathyroidism is treated with lifelong supplementation of calcium and calcitriol to a goal serum calcium level at the lower limit of normal. Reference: Abate EG,Clarke BL. Review of Hypoparathyroidism. Front Endocrinol (Lausanne). 2017; 7:172. Published 2017 Jan 16

Survival and quality of life in 23 patients with severe aplastic anemia treated with bone marrow transplantation (BMT)

1987 ◽  
Vol 54 (3) ◽  
pp. 137-146 ◽  
Author(s):  
W. Hinterberger ◽  
H. Gadner ◽  
P. H�cker ◽  
A. Hajek-Rosenmayr ◽  
W. Graninger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anemia ◽  
Marrow Transplantation ◽  
Severe Aplastic Anemia

Aplastic Anemia in Thailand: Incidence and Treatment Outcome from a Prospective Nationwide Population-Based Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 8-9
Author(s):  
Lalita Norasetthada ◽  
Somchai Wongkhantee ◽  
Jindaratn Chaipokam ◽  
Kanyaporn Charoenprasert ◽  
Suporn Chuncharunee ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Anabolic Steroid ◽  
Real World ◽  
Conflicts Of Interest ◽  
Bone Marrow Failure ◽  
Population Based ◽  
Annual Incidence ◽  
Severe Aplastic Anemia ◽  
Treatment Modalities ◽  
Population Based Study

Background: Incidence of Aplastic Anemia (AA) in Asia tends to be higher than in western countries, but contemporary real-world incidence and outcomes of AA in Asia remain limited. This study aimed to explore the incidence across the country regions and to evaluate the patient outcomes according to age, the severity of disease, and treatment modalities. Method: This is a prospective multicenter nationwide population-based observational study of patients with AA aged over 15 years old, diagnosed between August 1st, 2014 to July 31st, 2016, with a longitudinal follow-up period over 2 years, from 30 medical centers. Patients with suspected hypocellular MDS and congenital bone marrow failure syndrome were excluded. Results: During the study period of 2 years, there were 348 newly diagnosed patients with aplastic anemia, giving the annual incidence of 4.6 per million inhabitants. There was a higher annual incidence of severe (SAA) and very severe aplastic anemia (VSAA) (3.8 per million) than non-severe aplastic anemia (NSAA) (0.8 per million). The incidence was greater among older patients with a peak incidence in patients aged 60-89 years old. (Figure 1) There was a high variation in the geographic incidences across country regions, ranging from 2.6 to 6.6 per million per year. (Figure 2) The 2-year overall survival (OS) for NSAA, SAA, and VSAA were 65.5%, 49.3%, and 20.1%, respectively (P &lt; 0.001). Patients aged older than 60 years had the worst OS (42.6% as compared with 47.7% for the age 41-60 years and 64.5% for the age 15-40 years, P = 0.002). Among patients with SAA and VSAA (n = 280), the overall response rate (ORR) among patients treated with rabbit anti-thymocyte globulin and/or cyclosporin A (rATG±CsA) was significantly superior than those treated with CsA-based therapy and those treated with anabolic steroid (44.4% vs. 36.4% and 31.2%, respectively, P &lt; 0.001). Among evaluable patients, ORR after the 1st treatment with rATG±CsA at 3, 6, 12 and 24 months were 23.9%, 43.8%, 68.4% and 89.2%, respectively. The 2-year OS among SAA/VSAA patients treated with rATG±CsA, CsA-based therapy, and anabolic steroid were 54.8%, 54.5%, and 37.6% (P = 0.037), respectively (Figure 3). From multivariate analysis, age &gt; 60 years (HR 1.63, 95%CI, 1.14-2.33, P = 0.007), VSAA (HR 2.24, 95% CI, 1.45-3.46, P &lt; 0.001) and not receiving immunosuppressive therapy or anabolic steroid (HR 4.96, 95%CI, 2.88-8.54, P &lt;0.001), were independently associated with inferior OS among patients with SAA/VSAA. Conclusion: The incidence rate of AA in Thailand from this contemporary nationwide population-based study is high, especially in the elderly. Patients treated with rATG±CsA had superior survival than those receiving anabolic steroid. The real-world outcome of patients with SAA/VSAA, especially in those aged over 60 years, is substantially poor. Figure 1 Disclosures No relevant conflicts of interest to declare.

scholarly journals Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Huaquan Wang ◽  
Qi’e Dong ◽  
Rong Fu ◽  
Wen Qu ◽  
Erbao Ruan ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Severe Aplastic Anemia ◽  
Red Blood Cell Transfusion ◽  
Overall Survival Rate ◽  
Normal Range ◽  
Hematologic Response ◽  
Transfusion Independence ◽  
Recombinant Human Thrombopoietin

Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO) in severe aplastic anemia (SAA) patients receiving immunosuppressive therapy (IST).Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week). rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, bone marrow megakaryocyte recovery, and time to transfusion independence were compared.Results. Hematologic response was achieved in 42.5%, 62.5%, and 67.5% of patients receiving rhTPO and 22.9%, 41.6%, and 47.9% of patients not receiving rhTPO at 3, 6, and 9 months after treatment, respectively (P= 0.0665,P= 0.0579, andP= 0.0847, resp.). Subjects receiving rhTPO presented an elevated number of megakaryocytes at 3, 6, and 9 months when compared with those without treatment (P= 0.025,P= 0.021, andP= 0.011, resp.). The time to platelet and red blood cell transfusion independence was shorter in patients who received rhTPO than in those without rhTPO treatment. Overall survival rate presented no differences between the two groups.Conclusion. rhTPO could improve hematologic response and promote bone marrow recovery in SAA patients receiving IST.

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