Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia in a Child
Journal name: The Malaysian Journal of Medical Sciences
Original article title: The Co-Existence of Pure Red Cell Aplasia and Autoimmune Haemolytic Anaemia in a Child with Malignant Lymphoma
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Suhair Abbas Ahmed, Rosline Hassan
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: The Co-Existence of Pure Red Cell Aplasia and Autoimmune Haemolytic Anaemia in a Child with Malignant Lymphoma
Year: 2005
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) are two hematological conditions that, while known individually, rarely coexist. PRCA is characterized by normochromic, normocytic anemia, reticulocytopenia, and a reduction in erythroid elements in the bone marrow, often linked to Parvo virus B19 infection. Conversely, AIHA occurs due to the presence of autoantibodies that lead to the destruction of red blood cells. Documented cases involving both PRCA and AIHA, particularly in the context of malignant lymphoma, are sparse. This report presents a unique case of these two conditions coexisting in a 10-year-old boy with non-Hodgkin lymphoma in Malaysia, marking the first such report recorded in the region.
The Role of Parvovirus B19
Parvovirus B19 is recognized for its affinity for erythroid progenitor cells and can lead to significant hematological complications in immunocompromised individuals. In this documented case, following chemotherapy for malignant lymphoma, the patient displayed pronounced anemia and reticulocytopenia, coupled with the presence of giant pronormoblasts in bone marrow aspirate. This atypical cell formation was indicative of PRCA, suggesting a significant impact by Parvovirus B19 infection, despite negative serological results. The weakly positive direct Coombs test pointed towards a diagnosis of cold AIHA, though the patient's overall clinical presentation was complex, likely due to immunosuppression caused by both the underlying malignancy and the chemotherapy being administered. Thus, Parvovirus B19 must be considered in the differential diagnosis of anemia, especially in immunocompromised patients.
Conclusion
This case report highlights the rare and complex coexistence of PRCA and AIHA in a pediatric patient undergoing treatment for non-Hodgkin lymphoma. It emphasizes the importance of recognizing these hematological conditions as potential complications in immunocompromised patients, particularly in the context of viral infections like Parvovirus B19, even when serological tests yield negative results. Clinicians should maintain a high index of suspicion for PRCA and AIHA in similar clinical scenarios to ensure appropriate diagnosis and management.
FAQ section (important questions/answers):
What is the relationship between pure red cell aplasia and autoimmune hemolytic anemia?
Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) are rare coexisting conditions. PRCA is characterized by normochromic normocytic anemia and reticulocytopenia, whereas AIHA involves the destruction of red blood cells by autoantibodies.
How was PRCA diagnosed in the 10-year-old boy?
In the case of the 10-year-old boy, PRCA was suggested by the presence of giant pronormoblasts in the bone marrow aspirate, alongside low reticulocyte count that was disproportionate to the level of anemia observed.
Why might serological tests for Parvovirus B19 be negative?
In immunocompromised patients, such as those undergoing chemotherapy, serological tests for Parvovirus B19 may yield negative results despite ongoing infection, as the weakened immune response affects the detection of viral markers.
What is the significance of red cell clumping in this case?
Red cell clumping observed in the patient indicated a possible diagnosis of cold type AIHA. However, the weakly positive Direct Coombs test and absence of clinical symptoms suggested a transient response related to the underlying conditions.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia in a Child”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Blood:
Blood is crucial in the context of the case study as it pertains to the patient's hematological condition. The patient's anemia, reticulocytopenia, and the reliance on blood transfusions highlight the significance of blood in managing pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) during cancer treatment.
2) Viru (Vīṟu):
This term likely refers to 'virus,' specifically in the context of parvovirus B19, which is implicated in the development of PRCA. The association of viral infections with hematological disorders is significant, particularly for immunocompromised patients such as those undergoing chemotherapy for malignant lymphoma.
3) Chemotherapy:
Chemotherapy is a critical treatment method used in managing malignant lymphoma. In this case, it contributes to the onset of anemia and the combined complications of PRCA and AIHA. The effects of chemotherapy, such as cytopenias, necessitate monitoring for additional hematological complications arising during treatment.
4) Table:
The reference to 'table' pertains to the documentation of the patient's blood counts and bone marrow findings over time. Such tabulated data provide a clear visual representation of the patient's hematological course, aiding in the understanding of disease progression and responses to treatments.
5) Suffering:
Suffering captures the patient's experience of health deterioration due to non-Hodgkin lymphoma and its complications. It emphasizes the impact of the illness and its treatments on the quality of life, underscoring the importance of managing symptoms and complications, particularly in pediatric oncology.
6) Transmission:
Transmission refers to the spread of parvovirus B19, which can occur through respiratory secretions or blood products. Understanding the methods of viral transmission is vital for the prevention of infections in immunocompromised patients during chemotherapy, emphasizing infectious disease control strategies in medical settings.
7) Swelling:
Swelling in the context of the patient's case indicates clinical findings associated with lymphomas, such as soft tissue masses or lymphadenopathy. The examination of such swellings is integral to the diagnostic process, aiding in the determination of malignancy type and treatment strategies.
8) Epidemic:
Epidemic relates to the context of viral infections within populations, like parvovirus B19 during outbreaks. It raises awareness of how widespread infections can affect immunocompromised patients more severely, and highlights the importance of monitoring and testing for viruses in clinical practice, especially in pediatric oncology.
9) Disease:
Disease encompasses the pathological states affecting the patient, including non-Hodgkin lymphoma, PRCA, and AIHA. Understanding these diseases and their interactions is crucial for formulating effective treatment protocols, improving patient outcomes, and advancing knowledge in hematology and oncology.
10) Science (Scientific):
Science represents the field of study from which the understanding of hematological disorders and their treatments emerge. It underscores the significance of research and evidence-based practice in diagnosing and managing conditions such as PRCA and AIHA in patients undergoing cancer therapy.
11) Cancer:
Cancer, specifically non-Hodgkin lymphoma in this case, is a central factor influencing the patient's health. Its treatment leads to complications such as PRCA and AIHA, necessitating close monitoring and supportive care, which are critical in oncology for improving prognosis and quality of life.
12) Sharman (Śarma, Sarmā, Sarma, Sharma, Śarman):
Sharma refers to a cited author in the context of medical literature pertaining to cases of PRCA due to parvovirus B19. It indicates the importance of referencing previous studies to draw connections between observed cases and established research, contributing to a broader understanding of hematological conditions.
13) Arrow:
The term arrow likely refers to the illustration accompanying the case report, specifically pointing to a giant pronormoblast in the bone marrow aspirate slide. Such imagery is essential in medical literature for highlighting key findings and aiding in the visual learning of hematological abnormalities.
14) Genu (Geṇu):
Genu, although not explicitly defined in this context, may imply 'genus' in reference to the scientific classification of parvovirus B19. Understanding its taxonomy is relevant in virology and pathology, particularly when discussing its pathology and implications in the oncological setting.
15) Sang:
Sang is part of the term 'Vox Sang,' appearing in cited references concerning blood-related publications. It emphasizes the historical contributions to hematology by consolidating knowledge, methodologies, and findings that inform the understanding and management of blood-related disorders such as AIHA and PRCA.
16) Sign:
Sign refers to clinical indicators of disease, such as the presence of giant pronormoblasts in the bone marrow aspiration. Recognizing signs is essential for diagnosis, guiding treatment, and monitoring disease progression in the context of hematological disorders, particularly in patients with malignancies.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia in a Child’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Chemotherapy, Blood transfusion, Anaemia, Hepatitis B Virus, Immune response, Erythropoiesis, Histopathological examination, Hematopoiesis, Pancytopenia, Induction therapy, Epstein-Barr Virus, Acute lymphoblastic leukemia, Humoral immune response, Immunocompromised patient, Hepatitis C virus, Hemolytic anemia, Red Blood Cell, Direct Coomb's test, Human parvovirus B19, Serological test, Cytomegalovirus, Bone Marrow Aspirate, Non-Hodgkin lymphoma, Blood and blood products, Reticulocytopenia, Pure Red Cell Aplasia, Malignant lymphoma, Autoimmune haemolytic anaemia, Hepatitis A virus, Parvovirus B19 infection, Clin Microbiol Rev, Blood product, Peripheral red blood cell, Respiratory secretion.