Thrombocytopenia, anasarca, and severe inflammation

Montazeripouragha, Amanallah; Campbel, Christine M; Russell, James A.; Medvedev, N N; Owen, Daniel R.; Harris, Alison; Donnellan, Fergal; McCormick, Iain A.; Fajgenbaum, David C; Chen, Luke Y C

doi:10.1002/ajh.26651

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Elevated CRP levels are observed in cases of acute infections and inflammatory conditions. 9,10 In the development of reactive thrombocytosis, IL-6 assumes a significant role by actively promoting megakaryopoiesis. This influence occurs both through direct stimulation and indirectly by enhancing the production of thrombopoietin (Tpo) in the liver.…”

Section: Discussionmentioning

confidence: 99%

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Masooma Jaffer,

Omar Shahid,

Rumaisha Aslam

et al. 2024

TPMJ

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Objective: To assess the prevalence and underlying causes of thrombocytosis among patients seeking medical attention at a prominent tertiary care facility located in Lahore. Thrombocytosis, characterized by an elevated platelet count, can signify an array of underlying health conditions, and this research seeks to unravel the frequency of these causes within the study population. Study Design: Cross-sectional. Setting: Department of Pathology, Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to May 2020. Methods: A total of 150 patients were carefully selected from diverse medical specialties, including but not limited to medical, surgical, gynecological, obstetric, gastroenterological, nephrological, and intensive care units. The diagnostic criteria for thrombocytosis were aligned with the operational definition provided by the World Health Organization (platelet count exceeding >450 x 10^9/L) during the stipulated study period. Statistical analysis of gathered data was performed using SPSS version 17.0. Results: The findings of the study showcased that infections and iron deficiency emerged as the predominant contributors to thrombocytosis among the adult patient cohort. These factors were trailed by conditions like chronic infections, trauma accompanied by blood loss, and instances of splenectomy. Interestingly, instances of primary thrombocytosis, notably essential thrombocythemia, constituted a mere 2% of the overall sample size, signifying its rarity within this adult population. Conclusion: In the realm of thrombocytosis, the research highlights a notable prevalence of secondary thrombocytosis, while primary thrombocytosis remains a considerably infrequent occurrence among adults. The study emphasizes the significance of infections and iron deficiency anemia as the leading triggers for secondary thrombocytosis. Such insights contribute to an improved understanding of the spectrum of conditions associated with elevated platelet counts and may aid clinicians in effectively diagnosing and managing these underlying causes.

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Section: Discussionmentioning

confidence: 99%

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Masooma Jaffer,

Omar Shahid,

Rumaisha Aslam

et al. 2024

TPMJ

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“…However, our patient was in the nephrotic range of proteinuria due to secondary membranous glomerulonephritis, with a CRP level of approximately 3 mg/dl, ultimately resulting in ESRD requiring hemodialysis. Importantly, a recent case report demonstrated that an Asian male with the TAFRO subtype of iMCD required hemodialysis twice and could withdraw from dialysis by initiating IL-6 blockers ( 45 ). To the best of our knowledge, this is the first case report of chronic maintenance renal replacement therapy for iMCD.…”

Section: Discussionmentioning

confidence: 99%

Case report: Importance of early and continuous tocilizumab therapy in nephrotic syndrome associated with idiopathic multicentric Castleman disease: A case series

Kojima

Yamaguchi²,

Hashiguchi³

et al. 2023

Front. Med.

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Idiopathic multicentric Castleman disease (iMCD) is a systemic and polyclonal lymphoproliferative disease involving multiple organs, including the kidneys, due to the overproduction of interleukin-6 (IL-6). Recently, several reports have suggested that excessive IL-6 actions in iMCD could have a causal relationship with the development of diverse histopathological renal manifestations that cause nephrotic syndrome. However, the treatment for such cases remains unclear. We report a series of three cases of nephrotic syndrome due to iMCD that helps to delineate the importance of early and continuous therapy with the anti-interleukin-6 receptor antibody tocilizumab. First, treatment was suspended for infectious control, and the patient presented with nephrotic syndrome due to diffuse mesangial and endocapillary hypercellularity without immune deposits complicating acute kidney injury. Second, iMCD was treated with prednisolone alone. The patient suddenly developed nephrotic syndrome due to immune-complex glomerulonephritis, not otherwise specified, complicated with acute kidney injury. In the third case, nephrotic syndrome secondary to membranous glomerulonephritis was diagnosed, with a skin rash and IgE antibodies to tocilizumab, and was therefore treated with prednisolone alone. In contrast to the first two cases, the third progressed to end-stage renal disease on hemodialysis. Taken together, this series suggests that clinicians should maintain clinical vigilance for iMCD as a possible underlying component of nephrotic syndrome, since iMCD presents with a variety of renal pathologies. Prompt initiation and continuous administration of tocilizumab are likely key determinants of renal outcomes in such cases. In particular, when tocilizumab is suspended due to infection or in the perioperative period, consideration of its expeditious resumption should be made, taking into account both the withdrawal period and systemic conditions.

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Idiopathic multicentric Castleman disease - TAFRO results in high levels of mTOR activator SVEP1, tissue factor, and endotheliopathy

Lossos,

Brown,

Sheikhbahaei

et al. 2024

Blood Vessels, Thrombosis & Hemostasis

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Thrombocytopenia, anasarca, and severe inflammation

Cited by 3 publications

References 28 publications

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Case report: Importance of early and continuous tocilizumab therapy in nephrotic syndrome associated with idiopathic multicentric Castleman disease: A case series

Idiopathic multicentric Castleman disease - TAFRO results in high levels of mTOR activator SVEP1, tissue factor, and endotheliopathy

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