Hemolytic Uremic Syndrome Following Bone Marrow Transplantation: A Case Report and Review of the Literature

Loomis, Leonard J.; Aronson, Andrew J.; Rudinsky, R; Spargo, Benjamin H.

doi:10.1016/s0272-6386(89)80214-8

Cited by 35 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In an additional 16 cases of adult BMT NP reported in the literature and treated with plasmaphere sis, 7 cases are reported to have survived [13-15, 17-20, 22], In a more recent analysis of cases of all hemolytic syndromes at any time after BMT, plasmapheresis was found to be partially effective in reversing the hemato logic changes but not the decline in kidney function [31]. This treatment was reported successful in the 1 of 2 cases of its use in children with BMT NP [10,27], As shown in figure 3, the evolution of kidney function in BMT NP appears to follow a biphasic course. There is an initial, more rapid decline in GFR, with in some cases concurrent microangiopathic hemolysis.…”

Section: Resultsmentioning

confidence: 99%

Bone Marrow Transplant Nephropathy: Radiation Nephritis Revisited

Cohen

Lawton²,

Moulder³

1995

Nephron

View full text Add to dashboard Cite

Late-onset renal failure occurs in up to 20% of survivors of bone marrow transplantation. Total body irradiation is a major factor in this syndrome, so-called bone marrow transplant nephropathy (BMT NP), which is defined by disproportionate anemia, hypertension, and azotemia. Previous or concurrent chemotherapy may potentiate the effect of radiation on the kidney. Kidney function may decline acutely or more gradually, with eventual long-term stabilization. Patient survival is associated with control of the blood pressure. BMT NP is a recognized complication of bone marrow transplantation, which will require ongoing attention.

show abstract

Section: Resultsmentioning

confidence: 99%

Bone Marrow Transplant Nephropathy: Radiation Nephritis Revisited

Cohen

Lawton²,

Moulder³

1995

Nephron

View full text Add to dashboard Cite

show abstract

“…There have been at least 53 such patients reported in the literature to date. [13][14][15][16][36][37][38][39][40][41][42][43][44] Nineteen of 33 patients treated with plasma exchange alone had some clinical improvement, but only seven responding patients survived.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy following allogeneic bone marrow transplantation is associated with intensive graft-versus-host disease prophylaxis

Paquette

Tran

Landaw³

1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Thrombotic microangiopathy (TM), manifesting clinically as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome, is an uncommon complication after bone marrow transplantation (BMT). A retrospective analysis of potential risk factors for TM following allogeneic BMT was performed. Clinical data were analyzed from seven patients diagnosed with severe TM and 409 patients who underwent BMT during the same time period and who survived for at least 100 days afterwards. Six of the seven patients with TM received intensive GVHD prophylaxis consisting of cyclosporine, methotrexate and glucocorticoids, whereas only 66 of the 409 patients without TM received this regimen (P Ͻ 0.001, Fisher's exact test). This regimen was administered to patients older than 40 years, or recipients of a mismatched or unrelated allograft. Univariate analysis also revealed an increased risk of TM associated with the use of an unrelated bone marrow donor (P = 0.02), but no significant association with patient age or gender, diagnosis, amount of prior chemotherapy, transplant conditioning regimen or severity of GVHD. A multivariate exact logistic regression analysis revealed that only the type of GVHD prophylaxis had a significant impact on the risk for TM. The combined use of cyclosporine, methotrexate and glucocorticoids as GVHD prophylaxis may predispose to the development of TM following BMT. Keywords: thrombotic thrombocytopenic purpura; hemolytic uremic syndrome; bone marrow transplantation; graftversus-host disease Thrombotic microangiopathy (TM) is a pathological process characterized by occlusion of the microvasculature by hyaline thrombi resulting in microangiopathic hemolytic anemia, thrombocytopenia and end organ dysfunction. Clinically, TM manifests as hemolytic uremic syndrome (HUS) when the renal vasculature is primarily affected, or as thrombotic thrombocytopenic purpura (TTP) when there is diffuse vascular involvement. The onset of TM has been associated with infection by a variety of bacterial or viral pathogens. 1 There is a well-documented association between infection with E. coli strain O157:H7 and the occurrence of HUS. 2,3 Individuals infected with the human immunodeficiency virus have an increased incidence of TTP. 4 TM also occurs in relation to pregnancy; TTP tends to occur in the ante-partum period while HUS is more frequent post-partum. 1 Administration of chemotherapy, especially mitomycin C, has been associated with the development of HUS. 5 These various etiologies are thought to share the ability to induce injury to the vascular endothelium. Plasma exchange is highly effective therapy for TTP; HUS may also respond to this therapy. 3,6 TM is an uncommon complication of allogeneic bone marrow transplantation (BMT). More than 63 cases of TM have been reported to occur in this setting. 7 The first case of TM following allogeneic BMT was observed during the earliest use of cyclosporine (CsA) prophylaxis for graftversus-host disease (GVHD). 8 Subsequently, the occurrence of TM was found to be signifi...

show abstract

“…[1][2][3][4][5][6][7][8][9][10][11] Thrombotic microangiopathy is usually diagnosed on the basis of falling platelet counts and hemoglobin, Coombsnegative hemolytic anemia, schistocytosis, elevated lactate dehydrogenase (LDH), renal impairment, hypertension, and central nervous system changes in varying combinations. LDH elevation is a sensitive indicator of hemolysis, but is not specific for hemolysis secondary to microangiopathic damage.…”

mentioning

confidence: 99%

Red cell fragmentation (schistocytosis) after bone marrow transplantation

Zomas

Sašo

Powles

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Red cell fragmentation is often the earliest sign of thrombotic microangiopathy. Days +14, +28 and +42 blood films from 58 allograft and 32 autograft recipients were reviewed blind to determine the incidence and severity of schistocytosis (the number of fragmented red cells per 1000 red cells expressed as a percentage). Schistocytosis was graded as mild (Ͻ1%), moderate (1-1.9%) or severe (у2%). Schistocytes were seen in 99% of day 14 films (0.1-3.0%, median 0.4%), 97% of day 28 films (0.1-3.2%, median 0.4%), and 98% of day 42 films (0.1-4.3%, median 0.5%). Nine patients (10%) had severe fragmentation and 20 patients (22%) had moderate fragmentation at some time or the other. The difference in the extent of fragmentation between the days was not significant. Allogeneic BMT was associated with more extensive fragmentation than autologous transplantation on day 28 (P = 0.008) and day 42 (P = 0.02). Age, conditioning regimen and diagnosis had no influence. None of the patients followed-up for 6 months after transplant developed full-blown thrombotic microangiopathy. The occasional patient showing mild clinical and laboratory features of hemolysis responded well to adjustment of fluid balance and cyclosporine dose where applicable. Our data indicate that mild red cell fragmentation is a common morphologic finding after transplantation with no clinical significance in the absence of other clinical and laboratory findings suggestive of thrombotic microangiopathy, although patients with moderate or severe fragmentation should be monitored closely.

show abstract

Hemolytic Uremic Syndrome Following Bone Marrow Transplantation: A Case Report and Review of the Literature

Cited by 35 publications

References 8 publications

Bone Marrow Transplant Nephropathy: Radiation Nephritis Revisited

Bone Marrow Transplant Nephropathy: Radiation Nephritis Revisited

Thrombotic microangiopathy following allogeneic bone marrow transplantation is associated with intensive graft-versus-host disease prophylaxis

Red cell fragmentation (schistocytosis) after bone marrow transplantation

Contact Info

Product

Resources

About