속립성 결핵에서 골수침윤을 동반한 범혈구 감소증 1례

모성환,박관응,김창욱,김미자,정회상,박유환,정춘해,이호영,이호준 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.2

Miliary tuberculosis is commonly associated with various hematologic changes, such as, anemia, leukopenia, leukocytosis, monocytosis, leukemoid reaction, basophilia, dissemianted intravascular coagulation, and rarely pancytopenia. Pancytopenia in miliary tuberculosis has proved to be a grave prognostic indicator. The precise mechanism of pancytopenia in miliary tuberculosis is not yet known, so there is still much controversy. Bone marrow invasion is accepted as one of the possible mechanisms of pancytopenia acompanied with miliary tuberculosis. Authors experienced a rare case of pancytopenia and bone marrow invasion associated with miliary tuberculosis in a 47-year-o1d female. The bone marrow examination revealed caseous granulomas with a reactive plasmacytosis. The pancytopenia and symptoms were resolved by anti-tuberculosis chemotherapy and active supportive care. Tuberculosis os a common infection. Therefore, in the presence of pancytopenia, accompanied with pyrexia, milliary tuberculosis should always be considered.

범혈구감소증이 동반된 그레이브스병 1예

신종호,김시범,김동필,고봉석,김동순,공수정,이정애,김현진,김지명 대한내분비학회 2009 Endocrinology and metabolism Vol.24 No.4

Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves’ disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as suffering from Graves´disease with pancytopenia. After treatment with propylthiouracil, the blood cell counts were restored to normal as the patient achieved a euthyroid state. We report here on a case of Graves' disease that was complicated by pancytopenia, and all this was normalized after treatment for hyperthyroidism.

신장이식 후 발생한 Parvovirus B19에 의한 재발성 범혈구부전증 1례

신미선 ( Mi Seon Shin ),조정민 ( Jung Min Jo ),김민정 ( Min Jung Kim ),김경민 ( Kyung Min Kim ),이지영 ( Ji Young Lee ),지현숙 ( Hyun Sook Chi ),박수길 ( Su Kil Park ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6

Pure red cell aplasia due to parvovirus B19 infection after renal transplantation has been rarely reported, and few have been described about pancytopenia due to parvovirus B19. We report a case of recurrent pancytopenia due to parvovirus B19 infection in a renal transplant recipient. Ten days after transplantation, the patient developed severe pancytopenia (WBC 400/mm3, platelet 29,000/mm3, hemoglobin 6.8 g/dL) and his blood sample was positive for parvovirus B19 DNA PCR. Two weeks after 5-day administration of IVIG 400 mg/kg/day, pancytopenia resolved and tacrolimus was converted to cyclosporine A for reducing immunosuppressant potency. However, recurrent pancytopenia developed two months after IVIG treatment. Both blood and bone marrow samples were positive again for parvovirus B19 DNA PCR. Although pancytopenia persisted after another 5-day administration of IVIG 400 mg/kg/day, excellent hematological response has been achieved with single dose of IVIG 1 g/kg/day. Our case suggested that parvovirus B19 infection should be considered in renal transplant recipients with unexplained severe pancytopenia. High dose IVIG would be an effective therapeutic option, if the infection is recurrent or refractory to the usual dose of IVIG.

Long lasting mesalazine-induced pancytopenia in a patient with ulcerative colitis

Ko, Juyeon,Song, Hyun Joo,Han, Sanghoon,Moon, Chiyoon Institute for Medical Science 2019 The Journal of Medicine and Life Science Vol.16 No.2

Inflammatory bowel disease (IBD) is an immune-mediated chronic inflammatory intestinal condition. With development of various treatment options for IBD, 5-aminosalicylic acid (5-ASA) agents became the drugs of choice due to high efficacy and low risk of complication, specifically effective at inducing and maintaining remission in ulcerative colitis(UC). Pancytopenia caused by 5-ASA agents, especially by mesalazine, has been rarely reported compared with azathioprine, which is commonly used for glucocorticoid-dependent IBD and known to have risk of bone marrow suppression. In the present report, we describe the case of a 57-year-old woman diagnosed with UC, who developed pancytopenia due to adverse effect of mesalazine after recovery from azathioprine-induced pancytopenia. After withdrawal of mesalazine, the laboratory values consistent with myelosuppression continued for 3 months while pancytopenia from azathioprine remained only for 2 weeks. Since pancytopenia can be fatal due to its risk of severe bleeding and infection, close monitoring of clinical presentation is important when starting mesalazine and laboratory data should be evaluated whenever the patients present related symptoms. Furthermore, we suggest that complete blood cell counts should be considered when resuming mesalazine following the development of pancytopenia from any cause, as routinely recommended for azathioprine use.

범혈구감소증을 보인 브루셀라증 환자에서 치료 후 발생한 급성골수성백혈병 1예

김선형,김경표,한상훈,김영리,강성하 대한진단검사의학회 2015 Laboratory Medicine Online Vol.5 No.3

Human brucellosis is an important zoonotic disease and has a wide clinical spectrum. Nonspecific hematologic abnormalities related to brucellosis are frequently found, but pancytopenia is uncommon. Malignant diseases have been infrequently reported as a rare cause of pancytopenia in patients with brucellosis. We describe a patient with brucellosis and pancytopenia who was later diagnosed with acute myeloid leukemia. A 71-yr-old man was admitted to a hospital with fever and pancytopenia. Brucella was cultured from blood, and the bone marrow findings were in accordance with brucellosis. The patient’s clinical symptoms improved; however, he still showed pancytopenia after completion of medical treatment. After approximately 6 months, he was readmitted with pneumonia and pancytopenia. The second bone marrow examination revealed hypercellular marrow with increased number of blasts. The chromosome analysis showed 46,XY,trp(8)(q11.2q22)[8]/46,idem,del(7)(q22)[12]. The patient was diagnosed with acute myeloid leukemia with myelodysplasia-related changes. He refused further evaluation and therapy, and subsequently died while receiving conservative treatment. 브루셀라증은 중요한 인수공통감염병 중의 하나로 임상 증상은 다양하게 나타난다. 비특이적 혈액학적 이상소견이 브루셀라증과 연관되어 자주 나타날 수 있는데 반해, 범혈구감소증은 드물게 관찰되는 소견이다. 브루셀라증 환자에서 범혈구감소증의 원인으로 악성질환이 드물게 보고되고 있다. 저자들은 범혈구감소증을 보이는 브루셀라증 환자가 후에 급성골수성백혈병으로 진단받은 증례를 보고하고자 한다. 71세 남자 환자가 발열과 범혈구감소증을 주소로 내원하였다. 브루셀라균이 혈액배양에서 관찰되었고, 골수검사에서는 브루셀라증에서 관찰될 수 있는 소견을 보였다. 약물 치료 후 환자의 임상 증상은 호전되었으나, 범혈구감소증은 여전히 관찰되었다. 약 6개월 후 환자는 폐렴과 범혈구감소증으로 재입원하였다. 두 번째 골수검사가 시행되었고, 그 결과 세포충실도와 모세포가 증가된 소견을 보였다. 염색체 검사에서는 46, XY,trp(8)(q11.2q22)[8]/46,idem,del(7)(q22)[12]의 결과를 보였다. 환자는 골수형성이상관련급성골수성백혈병으로 진단되었다. 환자는 더 이상의 검사와 치료를 거부하고 보존치료를 받던 중 사망하였다

Pancytopenia and secondary myelofibrosis could be induced by primary hyperparathyroidism

LIM, D.-J.,OH, E. J.,PARK, C.-W.,KWON, H.-S.,HONG, E.-J.,YOON, K.-H.,KANG, M.-I.,CHA, B.-Y.,LEE, K.-W.,SON, H.-Y.,KANG, S.-K. BLACKWELL PUBLISHING LTD 2007 INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY Vol.29 No.6

<P>Summary</P><P>Hyperparathyroidism may be a precipitating factor important to the development of myelofibrosis: however, there has been only a few reports regarding myelofibrosis secondary to primary hyperparathyroidism. Recently, a rare case of pancytopenia caused by myelofibrosis in a 41-year-old woman who complained of general weakness and arthralgia presented to our clinical service. The patient was diagnosed with primary hyperparathyroidism with pancytopenia. Bone marrow biopsy revealed myelofibrosis. Right parathyroidectomy was performed and a parathyroid adenoma was totally excised. After surgery, the CBC counts and other clinical abnormalities gradually improved without further intervention. We concluded that the pancytopenia was because of bone marrow fibrosis resulting from primary hyperparathyroidism. Therefore, physicians should consider myelofibrosis secondary to primary hyperparathyroidism as a cause of pancytopenia in hypercalcemic patients, even though it is rare.</P>

십전대보탕가감방을 투여한 간세포암종 환자에서 범혈구감소증 호전 및 간수치 상승 증례

김종민,전형준,조종관,이연월,유화승,Kim, Jong-Min,Jeon, Hyung-Joon,Cho, Chong-Kwan,Lee, Yeon-Weol,Yoo, Hwa-Seung 대한한방내과학회 2013 大韓韓方內科學會誌 Vol.34 No.4

Objectives : To observe the therapeutic effects of an oriental herbal prescription in a hepatocellular carcinoma patient with splenomegaly and pancytopenia. Methods : Modified Sipjeondaebo-tang was prescribed three times a day to a hepatocellular carcinoma patient with splenomegaly and pancytopenia. Laboratory tests were carried out regularly to observe the therapeutic effects of the oriental herbal prescription for pancytopenia. Results : When treated with modified Sipjeondaebo-tang including Cinnamomi Cortex, the levels of white blood cells, red blood cells, hemoglobin, and hematocrit increased. However, aspartate transaminase, alanine transaminase, alkaline phosphatase, gamma-glutamic transpeptidase, total bilirubin, direct bilirubin levels also increased. Conclusions : Administering modified Sipjeondaebo-tang with Cinnamomi Cortex showed effect in improving pancytopenia but an increase in liver enzyme levels was also observed.

A Case of Pancytopenia Due to Copper Deficiency in Patient receiving Long-term TPN

( Jeong Wook Kim ),( Young Kim ),( Chang Hwan Choi ),( Sae Kyung Chang ) 한국정맥경장영양학회 2016 한국정맥경장영양학회 학술대회집 Vol.2016 No.-

Although copper (Cu) deficiency is a rare clinical situation dozens of case reports of its occurrence have accumulated in the last several decades. Cu deficiency causes a variety of hematological issues, morphologically mimicking malignancies including myelodysplastic syndrome (MDS). Patients receiving long-term TPN (total parenteral nutrition) experience Cu deficiency. We report a case of severe pancytopenia caused by Cu deficiency in patient receiving long-term total parenteral nutrition. A 77-year old man had a parkinson`s disease and experienced long-term paralytic ileus with anorexia and vomiting. Because the paralytic ileus lasted several months, TPN had been introduced 9 months. He showed paralytic ileus and urinary tract infection, and pancytopenia was discovered before treatment in our department. His laboratory data revealed severe pancytopenia: WBC 1,680/μL, neutrophils 29% (ANC 487/μL), Hb 7.3 g/dL, Ht 22.9%, platelets 9.1×104/μL, MCV 94.6 fl, MCH 33.1 pg, MCHC 34.9%, TIBC 198 μg/dL (247-335), UIBC 111 μg/dL (126-237), serum Fe 87 μg/dL (35-191), ferritin 465.6 ng/mL (30-400), vitamin B12 534 pg/mL (160-970), folate 9.7 ng/mL (3.6-12.9). Peripheral blood cell normocytic normochromic anemia. For the treatment of neutropenia and urinary tract infection, he was administered the G-CSF twice. But, neutropenia has not improved. The patient was transferred to our department for proper treatment of paralytic ileus, urinary tract infection and hematologic abnormalities. His laboratory findings showed serum Cu 2.5 μg/dL (75-145), and ceruloplasmin 2.0 mg/dL (20-60). He received injections of trace elements including 2.0 mg/day Cu. Neutropenia and thrombocytopenia disappeared after 1 week treatment of hypocupremia. After 5 weeks treatment, his hemoglobin level was 8.6 mg/dL. However, he died of sepsis caused by a urinary tract infection.

파종성 결핵에서 반응성 조직구 식혈증후군을 동반한 범혈구 감소증 1례

박선숙,강진형,김치홍,장은덕 大韓血液學會 1996 大韓血液學會誌 Vol.31 No.1

Evaluation of hematologic profile may be needed for patients treated with oxcarbazepine

Gu Hyun Jung,Su Jeong You 대한소아청소년과학회 2019 Clinical and Experimental Pediatrics (CEP) Vol.62 No.8

Purpose: The major side effects of treatment with oxcarbazepine (OXC) are skin rash and hyponatremia. Hematologic side effects are reported rarely. The aim of this study was to investigate the rate and types of the hematologic side effects of OXC. Methods: The medical records of 184 patients diagnosed with epilepsy or movement disorder and on OXC monotherapy, at the Department of Pediatrics of Inje University Sanggye Paik Hospital from July 2001 to July 2018, were retrospectively reviewed. Results: Of the 184 patients, 10 (5.4%) developed leukopenia in addition to pancytopenia and 2 (1.0%) developed pancytopenia. Leukopenia developed in 11 days to 14 years after OXC administration and was more frequent in males than in females (male vs. female, 9 vs. 1; Fisher exact test, P<0.05). Of the eight patients with leukopenia alone, 7 continued OXC treatment; 6 improved without intervention; 1 was lost to follow-up; and 1 received a reduced OXC dose, who improved after intervention. Pancytopenia developed within 2 months of initiation of OXC treatment. Both patients initially continued OXC. One improved within 1 month and continued treatment with OXC, but the other showed progression of the side effect, leading to the discontinuation of OXC and subsequent improvement within 1 month. There were no significant differences in the ages of the patients, OXC dose, and duration of OXC treatment between patients with and without these side effects of OXC (P>0.05, t-test). Conclusion: OXC-induced leukopenia is not rare and may result in pancytopenia. Patients being treated with OXC should be regularly monitored for abnormal complete blood count profiles.