Transient erythroid hypoplasia in a patient on long-term co-trimoxazole therapy

OMB No. 0704-01788A DA 2 7 9 0 2 2 h o u r re w e . ,n c l lnfIo me tim e To r re v ie w in g n s .tru c tio n s, se a rcnrin o ABSTRACT (Maximum 200 words)Acquired pure red cell aplasia (PRCA) has been associated with various lymphoproliferative conditions but its occurrence with Hodgkin's disease is rare. We report a case of PRCA occurring immediately following the completion of induction chemotherapy in a patient with Stage IIIB nodular sclerosing Hodgkin's disease. In vitro erythroid colony studies documented evidence for T cell mediated suppression of erythropoiesis and lack of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth.Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 ratios returned to normal.However, serum erythropoietin levels were inappropriately low.Subsequent treatment with erythropoietin induced a reticulocytosis and transfusion independence.Since discontinuing the erythropoietin, the patient has been able to maintain a hemoglobin of 100 g/L.This case illustrates that red cell aplasia occurring in the setting of Hodgkin's disease may be due to T cell mediated suppression of erythropoiesis.A response to cyclosporin may be masked by inappropriately low erythropoietin levels. )of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth. Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 , ratios returned to normal. However, serum erythropoietin levels were inappropriately low.

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Drug‐Induced Pure Red Cell Aplasia

Thompson,

Gales

1996

Pharmacotherapy

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Pure red cell aplasia (PRCA) is an uncommon hematologic disorder characterized by the absence of erythroblasts in otherwise normal bone marrow. It is commonly an autoimmune disorder sometimes associated with a congenital error. It may also be acquired in association with thymomas, hematologic malignancies, human parvovirus B19 infection, drugs, and other disease states. Thirty drugs have been implicated as causative in PRCA, but most literature reports describe only one or two patients. Data evaluating possible mechanisms of drug‐induced PRCA are extremely limited, with conflicting results from different investigators. The criteria we used were at least five patients reported, reports from at least three separate investigators, and a minimum of one case of probable causality or better using a published assessment scale. With these criteria, phenytoin, azathioprine, and isoniazid had sufficient evidence of causality. All three are documented causes of PRCA and should be considered in any case of selective erythrocyte aplasia.

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Transient erythroid hypoplasia in a patient on long-term co-trimoxazole therapy

Abstract: The occurrence of isolated erythroid hypoplasia in a patient on long-term treatment with co-trimoxazole is described. It is suggested that this haematological complication, which has not been previously reported, was due to hypersensitivity to the sulphonamide component.

Cited by 12 publications

References 16 publications

Acquired pure red cell aplasia

Acquired pure red cell aplasia

Pure red cell aplasia after chemotherapy for Hodgkin's lymphoma: In vitro evidence for t cell mediated suppression of erythropoiesis and response to sequential cyclosporin and erythropoietin

Drug‐Induced Pure Red Cell Aplasia

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