Etiology of Pancytopenia in Tabriz Shahid Ghazi Hospital:A Cross-sectional Study in Iran

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.

Pancytopenia and Pulmonary Tuberculosis: A Case Report

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.

Brucellosis presenting with pancytopenia and hearing loss:A case report

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.

Typhoid with pancytopenia:Revisiting a forgotten foe:Two case reports

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.

儿童及青少年巨幼细胞性贫血病因及临床特点变化分析

目的 探讨及分析近年来儿童巨幼细胞性贫血(MA)的病因及临床特点的变化。方法 对本中心13例MA患儿的临床资料进行回顾性分析,总结及探讨病因构成及临床特点的变化。结果 病因方面,13例患儿中10例处于青春期生长过快(占77%),9例饮食结构不合理(占69%)。临床特点突出表现为发病年龄明显滞后,中位年龄14岁,最小年龄6岁;就诊原因多为急性感染和出血,而早期的贫血、巩膜黄染、神经系统损害症状并未引起重视;外周血象改变明显,红系改变为著,均为大细胞性贫血,其中7例(54%)为重度贫血,8例(62%)全血细胞减少。骨髓流式细胞学突出改变为幼红细胞表面CD71和CD36表达减低。结论 儿童MA的病因及临床特点近年来逐渐发生变化,早期易被漏诊和误诊,需引起儿科医生重新重视。

1例艾沙康唑致患者全血细胞减少的病例分析

目的正确识别和应对艾沙康唑引起的全血细胞减少的不良反应,为该药的安全使用提供参考。方法临床药师通过参与1例严重感染合并肾功能不全的患者使用艾沙康唑后出现全血细胞减少的病例分析,筛查患者住院期间所用药物,并结合药物的半衰期和相关文献,评估了该不良反应与艾沙康唑的关系及可能的发生机制。结果与结论患者全血细胞减少与艾沙康唑的关系评估为“可能相关”。使用艾沙康唑时应提高警惕,避免同时联用相同机制或有潜在相互作用的药物。如疗程大于2周或用药前血液系统异常或合并肝肾功能损害或需要联合使用相同机制的药物者,可考虑增加血常规监测频率。

美罗培南再激发致严重血小板减少一例并文献复习

目的探讨美罗培南致血小板减少患者的临床特点,为临床安全用药提供参考。方法分析1例美罗培南抗感染治疗过程中引起血小板减少的病例,检索相关文献探讨美罗培南引起血小板减少的临床特点。结果美罗培南可致患者血小板减少,使患者住院时间延长。结论高龄、肾功能不全、联用其他抗菌药物或抗血栓形成药的患者使用美罗培南治疗过程中需主动监测相关药品不良反应。

Borderline lepromatous leprosy:A case report

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.

头孢他啶联合环丙沙星抗感染致全血细胞减少的病例分析

1例74岁男性泌尿道感染伴发热患者给予头孢他啶2 g, ivd, q12h联合环丙沙星0.4 g, ivd, q12h联合抗感染治疗。2天后患者临床症状好转,体温恢复正常,但出现全血细胞减少,血常规报危急值:WBC 1.49×10^(9)/L,RBC 2.67×10^(12)/L,PLT 97×10^(9)/L,NEU 0.57×10^(9)/L,NEU%38.2%。尿常规:白细胞2+,余正常;hs-CRP 48.30 mg·L^(-1);PCT 8.72 ng·mL^(-1)。考虑为头孢他定联合环丙沙星引起的药物不良反应,停用头孢他啶、环丙沙星后,予以重组人粒细胞刺激因子注射液(75μg, ih)单剂升白细胞支持治疗,12天后患者的全血细胞减少恢复[1]。

临床药师参与处置哌拉西林他唑巴坦与莫西沙星致三系减少患者的药学实践及体会

目的分析1例患者发生三系减少的可能原因与处置办法,为临床哌拉西林他唑巴坦(TZP)与莫西沙星(MFX)的安全合理使用提供参考。方法临床药师参与了1例使用TZP与MFX后发生三系减少患者的药学会诊与药学监护,综合考虑患者的用药情况和发病过程,对三系减少发生的可能原因进行分析和文献复习,并提出了处置建议。结果临床药师综合考虑患者的用药情况和病程,分析三系减少可能是由TZP与MFX引起的,遂建议停用TZP与MFX,并调整抗感染方案及给予对症处理。结论TZP与MFX存在血液系统的不良反应,临床药师应不断加强学习,在临床开展药学实践工作时发挥自身作用,提供相关药学监护,保障患者用药安全合理。

ROLE OF B LYMPHOCYTE AND ITS SUBPOPULATIONS IN PATHOGENESIS OF IMMUNORELATED PANCYTOPENIA

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.

Lymphomatoid Granulomatosis with Splenomegaly and Pancytopenia

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.

Detection of Pancytopenia Associated with Clinical Manifestation and Their Final Diagnosis

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.

以全血细胞减少为首诊的甲状腺功能减退症一例

甲状腺功能减退症不仅累及体内任何器官系统也累及造血系统,贫血是最常见的血液学受累表现,其他细胞系的影响极为罕见。该文报道了1例以全血细胞减少为首发表现的甲状腺功能减退症55岁女性患者的诊治过程,同时结合相关文献进行分析,以提高临床医师的诊治水平。

101例犬睾丸肿瘤病例的回顾性分析

调查犬睾丸肿瘤的发病及治疗情况,探讨原发肿瘤及骨髓抑制对疾病预后的影响。从中国农业大学动物医院2020年5月至2022年7月接诊的病例中筛选出101例符合要求的睾丸肿瘤病例,记录患犬的基本信息、实验室检查结果、诊断信息及治疗和预后情况进行统计学分析。结果显示,常见的睾丸肿瘤有间质细胞瘤(51.7%)、精原细胞瘤(27.3%)、支持细胞瘤(17.5%)。腹内隐睾常见的肿瘤类型为支持细胞瘤(76.9%),睾丸肿瘤的主要发病品种为贵宾犬(22.8%)、金毛寻回猎犬(19.8%)、杂种犬(8.9%)。睾丸肿瘤平均发病年龄为10.9岁,不同类型肿瘤发病年龄无显著差异(P>0.05)。并发全血细胞减少症的患犬预后差,存活期均未超过30 d。犬睾丸肿瘤患病动物的半年以上、1年以上和2年以上存活率分别为88.4%、73.8%和44.4%,死亡病例当中大部分(61.5%)死因与睾丸肿瘤无关。

1例儿童输注万古霉素致全血细胞减少症合并迟发型药物热的病例分析

目的 准确识别万古霉素较罕见的药品不良反应(ADR)——全血细胞减少症,以促进该药的安全使用。方法 通过1例化脓性髋关节炎患儿静脉输注万古霉素后发生全血细胞减少症合并迟发型药物热的病例报告,采用Naranjo评分结合文献资料,评估该ADR与治疗药物的关系及其可能的发生机制,提出儿童患者合理使用万古霉素的建议。结果与结论 该患儿发生的全血细胞减少症合并迟发型药物热与万古霉素的关联性为“很可能”。临床上全血细胞减少症合并迟发型药物热与感染加重导致的发热、血细胞减少较难区分,医护人员应提高对全血细胞减少症等万古霉素较罕见ADR的警觉性,药师应协助医护人员及时甄别ADR。儿童输注万古霉素初始剂量宜从60 mg/(kg·d)开始,且应在首次用药后48 h进行血药浓度监测并及时调整剂量,使万古霉素谷浓度维持在5~15 mg/L,以防止因血药浓度过高导致ADR的发生;对于万古霉素使用超过1周的患儿,应定期复查血常规,一旦发生全血细胞减少应立即停药,并根据情况给予对症治疗。

免疫性全血细胞减少症合并膜增生性肾小球肾炎

11岁男性患儿,既往有免疫性全血细胞减少症、继发性血友病、脑梗死病史。肾脏损害表现为大量蛋白尿伴少量镜下血尿,肾活检病理提示肾小球膜增生性病变,偶见血栓性微血管病(TMA)样病变,电镜下系膜区和内皮下大量微管状超微结构,直径8~12 nm,最终诊断为肾小球膜增生性病变(考虑与免疫复合物及TMA病变相关)。

143例全血细胞减少症患者骨髓细胞形态学分析研究

目的通过骨髓细胞形态学对全血细胞减少症患者的病因及疾病特点进行分析。方法 选取2018年5月~2020年10月143例河北省第七人民医院血液科就诊的初发全血细胞减少症患者进行骨髓涂片、活检检查结果进行回顾性分析。结果 143例全血细胞减少症患者中,血液系统疾病97例,占67.83%,其中急性白血病、再生障碍性贫血、骨髓增生异常综合征最为多见,占血液系统疾病总例数的78.35%。骨髓涂片联合骨髓活组织检查能够提高全血细胞减少患者的确诊率。血液系统疾病所致的全血细胞减少症患者血浆RBC、HB明显低于非血液系统疾病,差异有统计学意义(P <0.01)。血液系统疾病中,骨髓增生Ⅲ级以下者占70.10%,Ⅳ级以上者占29.90%;非血液系统疾病中,骨髓增生Ⅲ级以下者占52.17%,Ⅳ级以上者占47.83%,差异有统计学意义(χ^(2)=4.371,P=0.037)。结论 骨髓细胞形态学检查全血细胞减少症诊断中具有重要的意义。

针刺治疗效化疗所致造血功能损害的临床观察

分组比较了针刺和药物对放化疗所致造血功能损害患者的治疗效果，针刺组取曲池、内关、合谷、足三里、三阴交、大椎等穴位，行平补平泻手法，足三里、三阳交接电针；药物组用临床常规药物。结果表明，针刺治疗可使降低的白细胞数显著上升（Ｐ＜０．００１），疗效优于对照组（Ｐ＜０．０１）；血色素、血小板数低者，经针刺治疗后其均值皆明显上升（Ｐ＜０．０５和Ｐ＜０．０１），疗效优于或接近于对照组；对临床症状的改善，针刺组办优于对照组。

免疫相关性全血细胞减少症患者骨髓Th细胞比例及功能变化

目的探讨免疫相关性全血细胞减少症(IRP)患者骨髓中辅助性T淋巴细胞(Th)亚群数量、功能改变及在发病中的作用。方法用流式细胞术同期对照研究16例正常对照组、15例初诊IRP组、24例再生障碍性贫血(AA)组、14例骨髓增生异常综合征(MDS)组骨髓Th细胞改变情况;RT-PCR方法检测10例正常人、25例初诊IRP患者、9例AA患者、9例MDS患者未经体外刺激的骨髓单个核细胞(BMMNC)中Th1细胞的代表因子IFN-γ、IL-2和Th2细胞的代表因子IL-4、IL-10的基因表达。结果(1)骨髓中Th1细胞、Th2细胞及Th1/Th2比值正常对照组为0·42%、0·24%和1·57;初诊IRP组为0·58%、1·95%和0·31;AA组为4·42%、0·41%和21·22;MDS组为0·44%、0·84%和0·96。IRP组Th1细胞与正常对照组及MDS组无显著差异(P>0·05),显著低于AA组(P<0·01);但IRP组Th2细胞显著高于正常对照组、AA组(P<0·01),与MDS组差异未达统计学意义(P=0·054)。IRP组骨髓中Th2细胞占优势,Th1/Th2比值显著低于正常对照组、MDS组及AA组(P<0·01)。(2)与正常对照组比较,初诊IRP组Th2型细胞因子IL-4、IL-10mRNA表达明显增高(P<0·01),而Th1型细胞因子IFN-γ、IL-2mRNA表达无显著增高(P>0·05);AA组Th1型细胞因子显著增高(P<0·01),而Th2型无区别;MDS组未见细胞因子表达增高。结论IRP患者骨髓Th2细胞亚群增多,Th细胞平衡向Th2偏移,且Th2型细胞因子表达增高,细胞功能亢进,可能是IRP免疫发病环节之一,也表明IRP是一种不同于AA和MDS的全血细胞减少症。