Objective:Pancytopenia is characterized by a reduction in all three types of blood cells:erythrocytes,leukocytes,and platelets.Pancytopenia is caused by a wide range of diseases,leading to diagnostic conundrums.These ...Objective:Pancytopenia is characterized by a reduction in all three types of blood cells:erythrocytes,leukocytes,and platelets.Pancytopenia is caused by a wide range of diseases,leading to diagnostic conundrums.These causes can range from drug reactions to life-threatening diseases such as aplastic anemia and leukemia.This study aims to investigate the causes of pancytopenia,specifically focusing on age and gender differences among patients.Methods:This cross-sectional study includes patients of all ages diagnosed with pancytopenia,as indicated by a CBC/H1 showing a WBC count less than 4,000/μL,platelet count less than 150,000/μL,and hemoglobin levels below 12 g/dL in women and less than 13 g/dL in men.The study only included patients with pancytopenia who underwent bone marrow examination and were not subjected to chemotherapy or radiation therapy.Results:A total of 133 patients with pancytopenia were included in the study.The average age was 47.35±17.62 years old,with 66%of the participants being male and 34%being female.Acute leukemia,specifically acute myeloid leukemia(AML)and acute lymphoid leukemia(ALL),was identified as the primary cause of pancytopenia,accounting for 31.5%of cases.Megaloblastic anemia was the second most common cause,accounting for 30%of cases,followed by aplastic anemia at 7.5%.Conclusion:Pancytopenia,a condition marked by the decrease in both erythrocytes and leukocytes as well as thrombocytes,can arise from a myriad of causes.The main findings of this study revealed that megaloblastic anemia,acute myeloid leukemia(AML),and acute lymphoid leukemia(ALL)were the most common causes.Significantly,a considerable proportion of cases of pancytopenia can be attributed to acute leukemia.Hence,expeditious and accurate diagnosis is imperative and has the potential to save lives in such cases.展开更多
Objective To measure the quantities and apoptosis-related protein levels of B lymphocyte in the patients with immunorelated pancytopenia （IRP） and explore the action of B lymphocyte in the pathogenic mechanism of IR...Objective To measure the quantities and apoptosis-related protein levels of B lymphocyte in the patients with immunorelated pancytopenia （IRP） and explore the action of B lymphocyte in the pathogenic mechanism of IRP. Methods Quantifies of whole B lymphocytes and CD5^＋ B lymphocytes as well as the expressions of Fas and Bcl-2 in B lymphocytes in 35 patients with untreated IRP, 15 IRP patients in complete remission （CR）, and 10 normal controls were assayed by flow cytometry. The percentages of B lymphocyte and CD5^＋ B lymphocyte were significantly higher in untreated IRP patients than in CR IRP patients and normal controls （ P 〈 0. 05 ）, and there was no significant difference between the latter two groups （ P 〉 0. 05 ）. There was no significant difference of Fas expression in B lymphocyte among three groups （ P 〉 0. 05）. The expression of Bcl-2 in B lymphocyte was significantly higher in untreated patients than in CR patients or normal controls （ P 〈 0. 01 ）, and significantly higher in CR patients than in normal controls （ P 〈 0. 01 ）. The apoptosis. related index was significantly lower in untreated patients than in CR patients or normal controls （ P 〈 0. 05 ）, and signif. icantly lower in CR patients than in normal controls （ P 〈 0. 05 ）. The percentage of B lymphocyte was positively correlated with post-treated response time （ r = 0. 53, P 〈 0. 01 ）. Conclusion The production of auto-antibodies in IRP patients probably has some relationship with the abnormal quantifies of B lymphocyte and its subpopulations as well as with the inhibition of B lymphocyte apoptosis.展开更多
Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual ...Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual with tuberculosis (TB), but pancytopenia is rare [2]. Findings: In this report, we described a case of a 42 years man presenting bleeding and pancytopenia;bacteriological pulmonary TB was established by genotypic rapid test and treatment following the WHO guidelines on drug-sensitive TB treatment. Patient recovered entirely with the WHO recommended regimen associated with general and local treatment of the bleeding. Conclusion: This case report emphasizes the importance of always suspecting tuberculosis in a tuberculosis-endemic area, even when the clinical manifestations are atypical, like pancytopenia and also of properly investigating the differential diagnosis. Even though prognosis seems to be less good, actual treatment regimen is still effective.展开更多
BACKGROUND Brucellosis is one of the most common zoonotic infectious diseases in the world,with approximately 500000 new cases of human brucellosis diagnosed each year.Brucellosis can simulate various multi-system dis...BACKGROUND Brucellosis is one of the most common zoonotic infectious diseases in the world,with approximately 500000 new cases of human brucellosis diagnosed each year.Brucellosis can simulate various multi-system diseases,presenting atypical symptoms.Very few brucellosis cases with pancytopenia accompanied by a severe hearing loss have been reported.In the literature review,we could find only one similar case reported in the past.Moreover,this disease is easily misdiagnosed as a blood system disease leading to delayed treatment.Thus,it is important to improve clinicians'awareness of this disease.CASE SUMMARY A 64-year-old woman presented with dizziness and fatigue,accompanied by pancytopenia and severe hearing loss.Brucella melitensis was identified on blood culture.Anti-infective therapy with rifampicin(900 mg/d)and doxycycline(100 mg twice a day)was prescribed for 4 mo along with ceftriaxone 2 g/d for 1 mo.The patient showed a good response to antibiotic therapy.Her blood counts returned to normal followed by significant improvement in hearing.CONCLUSION Brucellosis should be considered in the differential diagnosis of patients presenting with pancytopenia and hearing loss.展开更多
Background: Pancytopenia is a common hematological parameter detected in Hematology department. It is important to find out the etiology of pancytopenia for the better management of patient. Pancytopenia represents a ...Background: Pancytopenia is a common hematological parameter detected in Hematology department. It is important to find out the etiology of pancytopenia for the better management of patient. Pancytopenia represents a wide range of age groups and most pancytopenia is purely of bone marrow dysfunction origin. However, other causes such as hypersplenism and SLE are also frequently encountered. Objectives: To differentiate various causes of pancytopenia, to evaluate the hematological parameters in pancytopenic cases, and to analyze clinical manifestations in cases of pancytopenia. Materials and Methods: There were 25 admitted cases of pancytopenia at Affiliated Hospital of Dali University between the calendar year 2013 and 2014. A detail study was done on the basis of age, gender, clinical features, typical laboratory investigations, bone marrow examination, and final diagnosis. Results and Conclusions: Among 25 cases studied, megaloblastic anemia was the common cause of pancytopenia and incidence of megaloblastic anemia was higher in males after 5th decade of life. Pancytopenic cases age was ranging from 15 to 80 years. Fatigue and dizziness were the most common clinical features presented.展开更多
BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a you...BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a young adult male presenting with febrile neutropenia whose blood and bone marrow cultures grew Salmonella typhi.He recovered before discharge from the hospital.The second was a primigravida who had an abortion following a febrile illness and was found to have pancytopenia.The Widal test showed high initial titers,and she was presumptively treated for typhoid.Convalescence showed a doubling of Widal titers.CONCLUSION Typhoid fever continued to show up as a fever with cytopenia demanding significant effort and time in working up such patients.In developing countries,the liaison with typhoid continues.展开更多
Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease...Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease. We report a 15-year-old boy presented with fever, dry cough and dyspnea from two months ago, after admission patient had nodular lesions on the left leg and hepatosplenomegaly. Then he manifested neurologic signs such as seizure, aphasia and right-sided hemiplegia. Chest X-ray and CT scan revealed bilateral pulmonary nodules predominantly in lower lobes and peripheral lung fields. Laboratory exams showed pancytopenia. Skin biopsy was done, and histopathological examination and immunohistochemistry evaluation confirmed lymphomatoid granulomatosis. He was treated with steroid and cyclophosphamide but succumbed by neurologic involvement.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
The protocol and evaluation of I therapy have already been established, and it is quite effective in general for patients with metastatic thyroid cancer under 40 years old with fine or occult type of pulmonary metasta...The protocol and evaluation of I therapy have already been established, and it is quite effective in general for patients with metastatic thyroid cancer under 40 years old with fine or occult type of pulmonary metastases (papillary adenocarcinoma). However, the response of bone metastasis to I therapy is limited to only a part of tumors and is temporary in most cases although high I accumulation is visualized on scintigram. We have encountered a 65-year-old man with thyroid cancer. At the age of 61, follicular thyroid cancer with multiple bone metastasis was diagnosed, total thyroidectomy was carried out, and subsequently I therapy was performed. Bone pain diminished展开更多
Rationale:Lepromatous leprosy can have many atypical presentations,obscuring early diagnosis.We present a case of lepromatous leprosy,presenting with atypical features,which made a diagnostic dilemma.Patient concerns:...Rationale:Lepromatous leprosy can have many atypical presentations,obscuring early diagnosis.We present a case of lepromatous leprosy,presenting with atypical features,which made a diagnostic dilemma.Patient concerns:A 48-year-old man presented with bilateral lower limb oedema and scaly“ichthyosis like”skin rash in both hands and feet,hepatosplenomegaly and pancytopenia,over a course of three months,without any classical features of leprosy.A skin biopsy revealed an unexpected diagnosis of borderline lepromatous leprosy.Diagnosis:Lepromatous leprosy.Interventions:Multi-drug regimen treatment with rifampicin,dapsone and clofazimine for lepromatous leprosy.Outcomes:The patient made a good clinical recovery.Lessons:In endemic settings,clinicians should be aware of similar atypical manifestations of leprosy to face the global challenge of eradicating this chronic deforming disease.展开更多
文摘Objective:Pancytopenia is characterized by a reduction in all three types of blood cells:erythrocytes,leukocytes,and platelets.Pancytopenia is caused by a wide range of diseases,leading to diagnostic conundrums.These causes can range from drug reactions to life-threatening diseases such as aplastic anemia and leukemia.This study aims to investigate the causes of pancytopenia,specifically focusing on age and gender differences among patients.Methods:This cross-sectional study includes patients of all ages diagnosed with pancytopenia,as indicated by a CBC/H1 showing a WBC count less than 4,000/μL,platelet count less than 150,000/μL,and hemoglobin levels below 12 g/dL in women and less than 13 g/dL in men.The study only included patients with pancytopenia who underwent bone marrow examination and were not subjected to chemotherapy or radiation therapy.Results:A total of 133 patients with pancytopenia were included in the study.The average age was 47.35±17.62 years old,with 66%of the participants being male and 34%being female.Acute leukemia,specifically acute myeloid leukemia(AML)and acute lymphoid leukemia(ALL),was identified as the primary cause of pancytopenia,accounting for 31.5%of cases.Megaloblastic anemia was the second most common cause,accounting for 30%of cases,followed by aplastic anemia at 7.5%.Conclusion:Pancytopenia,a condition marked by the decrease in both erythrocytes and leukocytes as well as thrombocytes,can arise from a myriad of causes.The main findings of this study revealed that megaloblastic anemia,acute myeloid leukemia(AML),and acute lymphoid leukemia(ALL)were the most common causes.Significantly,a considerable proportion of cases of pancytopenia can be attributed to acute leukemia.Hence,expeditious and accurate diagnosis is imperative and has the potential to save lives in such cases.
文摘Objective To measure the quantities and apoptosis-related protein levels of B lymphocyte in the patients with immunorelated pancytopenia （IRP） and explore the action of B lymphocyte in the pathogenic mechanism of IRP. Methods Quantifies of whole B lymphocytes and CD5^＋ B lymphocytes as well as the expressions of Fas and Bcl-2 in B lymphocytes in 35 patients with untreated IRP, 15 IRP patients in complete remission （CR）, and 10 normal controls were assayed by flow cytometry. The percentages of B lymphocyte and CD5^＋ B lymphocyte were significantly higher in untreated IRP patients than in CR IRP patients and normal controls （ P 〈 0. 05 ）, and there was no significant difference between the latter two groups （ P 〉 0. 05 ）. There was no significant difference of Fas expression in B lymphocyte among three groups （ P 〉 0. 05）. The expression of Bcl-2 in B lymphocyte was significantly higher in untreated patients than in CR patients or normal controls （ P 〈 0. 01 ）, and significantly higher in CR patients than in normal controls （ P 〈 0. 01 ）. The apoptosis. related index was significantly lower in untreated patients than in CR patients or normal controls （ P 〈 0. 05 ）, and signif. icantly lower in CR patients than in normal controls （ P 〈 0. 05 ）. The percentage of B lymphocyte was positively correlated with post-treated response time （ r = 0. 53, P 〈 0. 01 ）. Conclusion The production of auto-antibodies in IRP patients probably has some relationship with the abnormal quantifies of B lymphocyte and its subpopulations as well as with the inhibition of B lymphocyte apoptosis.
文摘Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual with tuberculosis (TB), but pancytopenia is rare [2]. Findings: In this report, we described a case of a 42 years man presenting bleeding and pancytopenia;bacteriological pulmonary TB was established by genotypic rapid test and treatment following the WHO guidelines on drug-sensitive TB treatment. Patient recovered entirely with the WHO recommended regimen associated with general and local treatment of the bleeding. Conclusion: This case report emphasizes the importance of always suspecting tuberculosis in a tuberculosis-endemic area, even when the clinical manifestations are atypical, like pancytopenia and also of properly investigating the differential diagnosis. Even though prognosis seems to be less good, actual treatment regimen is still effective.
文摘BACKGROUND Brucellosis is one of the most common zoonotic infectious diseases in the world,with approximately 500000 new cases of human brucellosis diagnosed each year.Brucellosis can simulate various multi-system diseases,presenting atypical symptoms.Very few brucellosis cases with pancytopenia accompanied by a severe hearing loss have been reported.In the literature review,we could find only one similar case reported in the past.Moreover,this disease is easily misdiagnosed as a blood system disease leading to delayed treatment.Thus,it is important to improve clinicians'awareness of this disease.CASE SUMMARY A 64-year-old woman presented with dizziness and fatigue,accompanied by pancytopenia and severe hearing loss.Brucella melitensis was identified on blood culture.Anti-infective therapy with rifampicin(900 mg/d)and doxycycline(100 mg twice a day)was prescribed for 4 mo along with ceftriaxone 2 g/d for 1 mo.The patient showed a good response to antibiotic therapy.Her blood counts returned to normal followed by significant improvement in hearing.CONCLUSION Brucellosis should be considered in the differential diagnosis of patients presenting with pancytopenia and hearing loss.
文摘Background: Pancytopenia is a common hematological parameter detected in Hematology department. It is important to find out the etiology of pancytopenia for the better management of patient. Pancytopenia represents a wide range of age groups and most pancytopenia is purely of bone marrow dysfunction origin. However, other causes such as hypersplenism and SLE are also frequently encountered. Objectives: To differentiate various causes of pancytopenia, to evaluate the hematological parameters in pancytopenic cases, and to analyze clinical manifestations in cases of pancytopenia. Materials and Methods: There were 25 admitted cases of pancytopenia at Affiliated Hospital of Dali University between the calendar year 2013 and 2014. A detail study was done on the basis of age, gender, clinical features, typical laboratory investigations, bone marrow examination, and final diagnosis. Results and Conclusions: Among 25 cases studied, megaloblastic anemia was the common cause of pancytopenia and incidence of megaloblastic anemia was higher in males after 5th decade of life. Pancytopenic cases age was ranging from 15 to 80 years. Fatigue and dizziness were the most common clinical features presented.
文摘BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a young adult male presenting with febrile neutropenia whose blood and bone marrow cultures grew Salmonella typhi.He recovered before discharge from the hospital.The second was a primigravida who had an abortion following a febrile illness and was found to have pancytopenia.The Widal test showed high initial titers,and she was presumptively treated for typhoid.Convalescence showed a doubling of Widal titers.CONCLUSION Typhoid fever continued to show up as a fever with cytopenia demanding significant effort and time in working up such patients.In developing countries,the liaison with typhoid continues.
文摘Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease. We report a 15-year-old boy presented with fever, dry cough and dyspnea from two months ago, after admission patient had nodular lesions on the left leg and hepatosplenomegaly. Then he manifested neurologic signs such as seizure, aphasia and right-sided hemiplegia. Chest X-ray and CT scan revealed bilateral pulmonary nodules predominantly in lower lobes and peripheral lung fields. Laboratory exams showed pancytopenia. Skin biopsy was done, and histopathological examination and immunohistochemistry evaluation confirmed lymphomatoid granulomatosis. He was treated with steroid and cyclophosphamide but succumbed by neurologic involvement.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
文摘The protocol and evaluation of I therapy have already been established, and it is quite effective in general for patients with metastatic thyroid cancer under 40 years old with fine or occult type of pulmonary metastases (papillary adenocarcinoma). However, the response of bone metastasis to I therapy is limited to only a part of tumors and is temporary in most cases although high I accumulation is visualized on scintigram. We have encountered a 65-year-old man with thyroid cancer. At the age of 61, follicular thyroid cancer with multiple bone metastasis was diagnosed, total thyroidectomy was carried out, and subsequently I therapy was performed. Bone pain diminished
文摘Rationale:Lepromatous leprosy can have many atypical presentations,obscuring early diagnosis.We present a case of lepromatous leprosy,presenting with atypical features,which made a diagnostic dilemma.Patient concerns:A 48-year-old man presented with bilateral lower limb oedema and scaly“ichthyosis like”skin rash in both hands and feet,hepatosplenomegaly and pancytopenia,over a course of three months,without any classical features of leprosy.A skin biopsy revealed an unexpected diagnosis of borderline lepromatous leprosy.Diagnosis:Lepromatous leprosy.Interventions:Multi-drug regimen treatment with rifampicin,dapsone and clofazimine for lepromatous leprosy.Outcomes:The patient made a good clinical recovery.Lessons:In endemic settings,clinicians should be aware of similar atypical manifestations of leprosy to face the global challenge of eradicating this chronic deforming disease.
