A Rare Concurrence of Hodgkin’s Lymphoma, Sickle Cell Disease and Diabetes Mellitus

2018 ◽  
Vol 40 (2) ◽  
pp. 118-120 ◽  
Author(s):  
Zainab Abdulmajeed Toorani ◽  
Srishma Sridhar ◽  
Wilfredo Roque
Keyword(s):  
Diabetes Mellitus ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Cell Disease

Learning Not to Judge a Book By Its Cover: A Case Series of Malignancy Masquerading As Common Presentations of Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4872-4872 ◽  
Author(s):  
Ahmar Urooj Zaidi ◽  
Lo'Rell Martin ◽  
Michael U Callaghan ◽  
Sharada A. Sarnaik ◽  
Jeffrey W Taub
Keyword(s):  
Cancer Therapy ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Research Funding ◽  
Hodgkin’S Lymphoma ◽  
Fetal Hemoglobin ◽  
Signs And Symptoms ◽  
Hodgkin's Lymphoma ◽  
Additional Patient ◽  
Cell Disease

Abstract Background: Sickle cell disease affects 100,000 people in the United States. Cancer does not appear to be more common in individuals with sickle cell disease however many presenting signs and symptoms of cancer overlap with signs and symptoms of sickle cell disease, complicating diagnosis. Furthermore, sickle cell disease can complicate surgical, chemo- and radio- therapies for malignancy. Methods: We reviewed the past 46 years experience of cancers in children with sickle cell at a large urban pediatric referral center. We identified 5 cases and reviewed the presentations, treatments, response to therapy, sickle cell complication and laboratory values, including transfusion needs and effect of chemotherapy on fetal hemoglobin levels. Results: We identified five cases of malignancies in children with sickle cell disease including cases of acute lymphoblastic leukemia (ALL), Hodgkin's lymphoma, Non-Hodgkin's lymphoma (NHL), Wilms tumor and renal cell carcinoma. An additional patient with sickle cell trait was diagnosed with metastatic renal medullary carcinoma. The patients were ages 6-18 years old at diagnosis and 4 were female. All had delays in diagnosis as their initial signs and symptoms overlapped with sickle cell disease (abdominal mass mimicking splenomegaly, low blood counts, fever and posterior reversible encephalopathy syndrome, hematuria). All five achieved complete remission with multi-modality therapy (excluding stem cell transplants) and are currently doing well 1- 20 years after treatment. Admissions for pain were reduced during and for some period after cancer therapy and 2 patients had marked, and in one case, prolonged elevation of fetal hemoglobin after therapy. Discussion: Children with sickle cell develop cancers that can be confused for sickle cell related complications. Cancer therapy can be well tolerated and successful in children with sickle cell. Sickle cell complications are decreased during cancer therapy likely secondary to frequent therapy related transfusion and therapy induced increases in fetal hemoglobin. Disclosures Callaghan: Biogen: Honoraria; Bayer: Honoraria; CSL Behring: Honoraria; Baxalta: Honoraria, Research Funding; Grifols: Honoraria; Roche: Honoraria, Research Funding.

Non-Hodgkin's Lymphoma Associated with Sickle Cell Disease: A Case Report

1987 ◽  
Vol 73 (5) ◽  
pp. 523-524 ◽  
Author(s):  
Fortunato Morabito ◽  
Vincenzo Callea ◽  
Maura Brugiatelli ◽  
Domenico D'Ascola ◽  
Alfio Palazzolo ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Hodgkin’S Lymphoma ◽  
Alternative Explanation ◽  
Hodgkin's Lymphoma ◽  
Cell Disease ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Chance Event ◽  
Homozygous Sickle Cell Disease

A case of non-Hodgkin's lymphoma with leukemic spread in a patient affected with homozygous sickle cell disease is reported. This association has not been previously described. A correlation between the malignancy and the hemoglobinopathy could not be etiologically ascertained; therefore, an alternative explanation to a chance event cannot be offered.

scholarly journals Adverse Outcomes in Concurrent Sickle Cell Disease and Hematological Malignancies

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5889-5889
Author(s):  
Stuthi Pavani Perimbeti ◽  
Kevin Ye Hou ◽  
Sabarina Ramanathan ◽  
Adonas Woodard ◽  
Daniel Kyung ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Hodgkin’S Lymphoma ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Hodgkin's Lymphoma ◽  
Cell Disease ◽  
Chi Square ◽  
Risk Of Death ◽  
Chi Square Analysis

Abstract Introduction: Case reports have suggested that there is an increased risk of hematological malignancies with sickle cell disease (SCD). We aimed to investigate the prevalence and mortality of select hematological malignancies, including: acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), polycythemia vera (PV), essential thrombocytopenia (ET), Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), primary myelofibrosis (PMF) in patients hospitalized with SCD. Methods: We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample to identify the hospitalizations with SCD using ICD-9 codes 282.6, 282.60, 282.61, 282.62, 282.63, 282.64, 282.68, 282.69 from 1999 to 2014. Cases were then stratified based on the concurrent presence of the above hematological malignancies. The percentages of patients with each type of hematological malignancy were obtained using Chi-square analysis. In addition, we compared outcomes between patients with and without SCD who had hematological malignancies. Bivariate analysis for in-hospital mortality percentage was performed using Chi-square test. Multivariate analysis to evaluate the risk of death during hospitalization was performed using Cox proportional hazard regression with alpha set at 0.05. Results: There were 307,424 admissions (weighted=1,513,168) with SCD. Within these admissions, 0.04% (n=516) were associated with AML, 0.05% (n=720) with HL, 0.02% (n=47) with ALL, 0.07% (n=1,028) with NHL, 0.69% (n=10,654) with ET, 0.01% (n=20) with PMF and 0.01% (n=18) with PV. The hazard ratio for mortality (95% C.I.) with SCD compared to without SCD was 3.60 (1.24-4.67) for AML (p <0.001), 4.56 (2.78-6.78) for ET (p <0.001), 2.37 (1.41-5.67) for NHL (p=0.003), 1.5 (0.8-4.5) for HL (p=0.08), 1.1 (0.5-3.2) for ALL (p=0.04), 1.3 (1.1-3.2) for PMF (p= 0.03) and 1.7 (0.6-2.9) for PV (p=0.05). Discussion: The most frequently encountered hematological malignancy in patients with SCD was ET, followed by NHL and then HL. After controlling for multiple confounders including age, race, sex, comorbidities and socioeconomic status, the hazard of death during hospitalization with SCD, ET, AML, NHL and ALL are significantly higher compared to those without SCD. While uncommonly encountered, concomitant hematological malignancy and SCD portends a significantly worse outcome, particularly in ET and AML. Potential explanations include iron overload from prior transfusions, increased infection risk due to asplenia and vascular damage from previous vaso-occlusive events. Newer advances in the management of SCD might improve subsequent outcomes in hematological malignancies. Disclosures No relevant conflicts of interest to declare.

Venous Thromboembolism (VTE) Characteristics among White- and Black-Americans: a Cross Sectional Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3831-3831 ◽  
Author(s):  
John A. Heit ◽  
Michele Beckman ◽  
Althea Grant ◽  
Nigel S. Key ◽  
Marilyn J. Manco-Johnson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Sickle Cell Disease ◽  
Renal Disease ◽  
Black Men ◽  
Sickle Cell ◽  
Chronic Renal Disease ◽  
Black Americans ◽  
Lower Proportion ◽  
Cell Disease ◽  
Baseline Characteristics

Abstract Background: Compared to Whites, Black-Americans may have a 40% higher incidence of idiopathic VTE. However, whether other VTE characteristics vary by race is uncertain. Objective: To compare demographic and baseline characteristics among White- and Black-Americans with VTE. Methods: Using a standardized data-collection form, demographic and baseline characteristics were prospectively collected from consecutive consenting patients enrolled in seven Thrombosis and Hemostasis Centers from August 2003 to March 2008. For patients with objectively diagnosed VTE, demographic and baseline characteristics were compared among White- and Black-American VTE patients, both overall, and by age and gender. Results: Among 1960 White- and 368 Black-Americans with VTE, compared to Whites, Blacks had significantly less isolated DVT (73.9% vs. 86.5%, p<0.001) and significantly more PE ± DVT (45.1 vs. 39.6%, p=0.05). Blacks and Whites did not differ in mean age (43.4 vs. 44.3 years), but a significantly higher proportion of Black men VTE patients were in age groups 20–39 and 80+ years. Blacks and Whites differed significantly by gender, with a significantly higher proportion of Black women with VTE (69.8% vs. 59.1%, p=0.0001). Blacks had a significantly higher mean BMI (32.3 vs. 29.4 kg/m2, p<0.0001), a significantly lower proportion with recent surgery or trauma, active cancer and infection, and a significantly lower proportion with a family history of VTE or documented thrombophilia (solely due to reduced Factor V Leiden and Prothrombin G20210A prevalence). Conversely, Blacks had a significantly higher proportion with hypertension, hyperlipidemia, diabetes mellitus, chronic renal disease and dialysis, HIV and sickle cell disease. The two races did not differ significantly regarding the proportion with idiopathic VTE, CHF, CAD/MI, peripheral artery disease, stroke or other chronic neurological disease (i.e., cerebral palsy), chronic liver disease or autoimmune disease, including antiphospholipid syndrome. Compared to White women VTE patients, Black women VTE patients had a significantly lower proportion with recent surgery, trauma, infection, oral contraceptive use and possibly hormone therapy; and a significantly higher proportion with idiopathic VTE, hypertension, diabetes mellitus, chronic renal disease, HIV and sickle cell disease. Compared to White men VTE patients, Black men VTE patients did not differ significantly regarding recent surgery, trauma, cancer, infection or autoimmune disease, but Black men had a significantly higher proportion with hypertension, diabetes mellitus, HIV and sickle cell disease. Black and White men with VTE did not differ significantly regarding idiopathic VTE, CHF, CAD/MI, stroke, peripheral arterial disease and chronic renal disease. Conclusion: White- and Black-Americans with VTE differ significantly regarding demographic and baseline characteristics that may be risk factors for VTE.

Concurrent Diabetes Mellitus and Sickle Cell Disease

Diabetes Care ◽  
1979 ◽  
Vol 2 (3) ◽  
pp. 327-327
Author(s):  
G. Triplett ◽  
S. Eichold
Keyword(s):  
Diabetes Mellitus ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease

scholarly journals Type 2 Diabetes Mellitus in Patients with Sickle Cell Disease: A Population-Based Longitudinal Analysis of Three Cohorts

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4817-4817
Author(s):  
Jifang Zhou ◽  
Jin Han ◽  
Edith A. Nutescu ◽  
William Galanter ◽  
Surrey M. Walton ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Health Plan ◽  
Population Based ◽  
Cell Disease ◽  
Clinical Cohort

Abstract Introduction The prevalence and incidence of type 2 diabetes mellitus (T2DM) in the United States (U.S.) is increasing with more than 100 million adults living with diabetes or pre-diabetes. Population-based evidence on the prevalence and risks for T2DM in patients with sickle cell disease (SCD) is limited. This study measured the prevalence of T2DM in patients with SCD and clinical characteristics associated with its incidence in a large commercially insured adult SCD cohort and also an academic institution-based clinical cohort. Methods We performed a population-based cohort study of commercially-insured health plan enrollees using the Truven MarketScan® Research Databases. Patients with SCD (1 inpatient or 2 outpatient claims that are at least 30 days apart) were identified and sampled each calendar year between 2009 and 2014. Prevalence in each closed cohort of continuously enrolled patients was determined per calendar year. Incidence rates of T2DM were estimated and compared with adult non-Hispanic Black respondents to the National Health and Nutrition Examination Survey (NHANES) over the same study period (2009-2014). Among SCD patients, multivariable Cox proportional hazard models were used to identify factors associated with incident T2DM, adjusting for relevant patient characteristics. Finally, prevalence of T2DM was measured in a cohort of patients with SCD aged ≥20 years at first medical encounter at the University of Illinois at Chicago (UIC) from January 2008 to December 2017. Prevalent T2DM was identified through a combination of diagnosis codes, self-reporting, anti-diabetic medications excluding insulin and glucose tests in outpatient settings. Results Among 7,070 health plan enrollees with SCD, the median age (mean) was 37.0 (38.9) years and 60.8% were female. Compared to SCD patients without T2DM, more SCD patients with T2DM had nephropathy (28.0% vs. 9.5%; p<0.001), neuropathy (17.7% vs. 5.2%; p<0.001), and history of stroke (24.1% vs. 9.2%; p<0.001). The standardized prevalence of T2DM among patients with SCD showed a modest increase from 15.7% to 16.5% from 2009 to 2014 (p trend=0.0259), and SCD patients had comparable prevalence of T2DM compared to the NHANES subjects (18.2%). [Figure A] Over 17,024 person-years, we observed a crude incidence rate for T2DM of 25.4 per 1,000 person-years. Risk of developing T2DM in patients with SCD increased with age, and incident T2DM was associated with comorbid hypertension (HR=1.45, 95%CI 1.14-1.83) and dyslipidemia (HR=1.43, 95%CI 1.04-1.96). [Figure B] Of the 672 adults in the UIC cohort of patients with SCD, 61.1% were female, the median (mean) age was 30.0 [32.9] years, and 478 (71.1%) had homozygous HbS disease (HbSS). A total of 76 (11.3%) patients had T2DM, with the highest prevalence among SCD patients ages ≥ 40 years (50/190, 26.3%). [Figure C] Abnormal glucose test results (≥200 mg/dl) were documented in 41 patients with mean (SD) of 294 (94) mg/dl. Among 31 patients with abnormal fructosamine tests (>285 µmol/L), the mean (SD) fructoasmine value was 392 (90) µmol/L. Conclusion We present evidence describing the prevalence of T2DM in patients with SCD both in a commercially-insured population and from an institution-based clinical cohort. These findings were similar to a general African American population with an increasing trend in T2DM over recent years. These trends support the routine screening for T2DM in patients with SCD, especially those of older age and with presence of comorbid hypertension and/or dyslipidemia. Disclosures No relevant conflicts of interest to declare.

scholarly journals Fusarium-Induced Cellulitis in an Immunocompetent Patient With Sickle Cell Disease: A Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962093430
Author(s):  
Shaher Samrah ◽  
Aroob Sweidan ◽  
Abdelwahab Aleshawi ◽  
Mahmoud Ayesh
Keyword(s):  
Diabetes Mellitus ◽  
Sickle Cell Disease ◽  
Lower Extremity ◽  
Sickle Cell ◽  
Fungal Infections ◽  
Fusarium Species ◽  
Immunocompetent Patient ◽  
Minor Trauma ◽  
Cell Disease ◽  
Patients With Diabetes

Fungal infections due to Fusarium species are mostly present in immunocompromised and patients with poorly controlled diabetes mellitus. We report a case of lower extremity skin infection caused by Fusarium species in a 61-year-old woman diagnosed with sickle cell disease. Single skin ulceration caused by Fusarium species can result from fungal inoculation into damaged tissue, so any condition that damages the skin can be considered as a risk factor for inoculation. Long-standing sickle cell disease may develop vaso-occlusion in the skin that can produce lower extremity ulcers and myofascial syndromes. The mechanism is not completely characterized, but compromised blood flow, endothelial dysfunction, thrombosis, inflammation, and delayed healing are thought to contribute to locally compromised tissue that may eventually lead to opportunistic infection such as in our case. Other factors contribute to the pathophysiology of lower extremity ulcers such as diabetes mellitus, with the resulting peripheral vascular ischemia causing poor circulation to the lower extremity, and peripheral neuropathy, which can make patients with diabetes unaware of minor trauma leading to the development of skin infections.

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