1/9. omeprazole-induced leukopenia. A case report.BACKGROUND: omeprazole has been marketed in france since 1989, for the healing of peptic ulcers, erosive reflux oesophagitis, and the zollinger-ellison syndrome. However, the drug has been associated with serious adverse reactions, including haemolytic anaemia and acute interstitial nephritis. More recently, an autoimmune syndrome induced by omeprazole has been described. OBJECTIVE: We present here a clinical history and an in vitro test of cytotoxicity linking leukopenia to omeprazole. RESULTS: A 37-year-old woman was hospitalized in the intensive care unit of our hospital with acute pulmonary insufficiency secondary to pneumonia. 72 h after starting omeprazole treatment, a decrease in leucocyte count was observed. The leukopenia was maximal on day 22: total white cell count was 2. 1x109/l, and neutrophil count was less than 0.75x109/l. In order to find the cause of this leukopenia, an in vitro cytotoxicity test was performed. The test was positive only when patient neutrophils and patient serum were in the presence of omeprazole. This cytotoxicity seems to be complement-dependent, as in the presence of heated serum, the omeprazole toxic effect was substantially reduced. CONCLUSION: This case report suggests that the leukopenia was associated with omeprazole.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
2/9. Chronic intoxication by doxycycline use for more than 12 years.We report the clinical case of a 12-years' intoxication by doxycycline. A patient with a depersonalization and derealization syndrome took 1 g doxycycline per day. In addition to hepatocellular necrosis with cholestasis, nephrotoxicity, leukopenia, anaemia and skin hyperpigmentation he suffered from hitherto unreported adverse cardiac events as intermittent supraventricular tachycardia and sporadic Wenckebach heart block. Despite a long period of self-medication these side-effects were reversible.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
3/9. Immune cytopenias as the presenting finding in primary sjogren's syndrome.A diagnostic delay of several years in primary sjogren's syndrome is common, even in patients who present with sicca symptoms. It is much more likely in cases with prominent symptomatic extraglandular involvement. We report on three such patients who presented as Coomb's positive haemolytic anaemia, systemic symptoms with agranulocytosis and gingival bleeding due to immune thrombocytopenia, to alert clinicians to the fact that primary sjogren's syndrome may present as clinically significant immune-mediated cytopenia in the absence of sicca symptoms. sjogren's syndrome, a common autoimmune disorder, should be considered in the differential diagnosis of apparently 'idiopathic' cytopenias and actively sought by directed history, Schirmer test and autoantibody screening.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
4/9. Severe refractory sarcoidosis in a 64-year-old man with persistent leucopenia.We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
5/9. Acquired copper deficiency following prolonged jejunostomy feeds.A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.- - - - - - - - - - ranking = 3keywords = anaemia (Clic here for more details about this article) |
6/9. Haematologic findings in patients with renal carcinoma.Haemoglobin concentration and leukocyte and platelet counts were studied in 122 patients with renal carcinoma, 104 of whom subsequently underwent nephrectomy. In 61 of the operable patients the tumour was located within the renal capsule (group I) and in the other 43 it had invaded the perinephric tissues (group II). Eleven of the group II patients also had distant metastases in one or two sites. Multiple distant metastases precluded renal surgery in 18 patients (group III). Normochromic anaemia (haemoglobin less than 120 micrograms/l) was found in 17% and leukocytosis (greater than 8 x 10(9)/l) in 25% of the group I patients. The corresponding frequencies for group III were 72 and 67%. Severe anaemia was found in patients with localized tumours as well as in patients with extensive metastases. thrombocytosis (400-800 x 10(9)/l) occurred in less than 20% of the patients in groups I and II, but in 42% in group III. thrombocytopenia (less than 200 x 10(9)/l), on the other hand, which was present in 31% of the group I patients, was less common in those with metastasizing tumours. Haematologic anomalies in renal carcinoma suggest either bone-marrow metastases of tumour-induced mechanisms such as production of erythropoietin or thrombopoietin and phagocytic and chemotactic effects of tumour cells or auto-immune processes. When uncorrected by nephrectomy in patients without signs of metastases, such haematologic findings suggest concomitant blood disorders.- - - - - - - - - - ranking = 2keywords = anaemia (Clic here for more details about this article) |
7/9. parvovirus infection causing red cell aplasia and leukopenia in rheumatoid arthritis.A case of acute parvovirus B19 infection causing fever, anaemia, leukopenia, and red cell aplasia, in a patient with chronic rheumatoid arthritis is described. The patient had received low doses of corticosteroids for several years, and a small dose of methotrexate recently. There was no evidence of haemolytic anaemia, iron deficiency or drug toxicity. Recovery was associated with the development of antibodies against parvovirus B19, and clearance of viraemia as detected by the polymerase chain reaction. Possible mechanisms for the development of leukopenia are discussed, but there was no evidence for haemophagocytosis.- - - - - - - - - - ranking = 2keywords = anaemia (Clic here for more details about this article) |
8/9. Ghosal haemato-diaphyseal dysplasia: a new disorder.We describe two siblings, products of a first cousin marriage, with diaphyseal dysplasia, severe anaemia, leukopenia, and thrombocytopenia. Radiologically, both had wide medullary cavities with discrete cortical hyperosthosis. Bone marrow was hypocellular. These, and six similar cases in the literature [6], suggest that they represent a form of diaphyseal dysplasia differing from Camurati-Engelmann disease by their radiological appearance, associated haematological abnormalities and autosomal recessive inheritance.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
9/9. Autoimmune haemolytic anaemia, immune thrombocytopenia, and leucopenia. An unusual presentation of Hodgkin's disease.We report an unusual case of nodular sclerosing Hodgkin's disease in a 17-year-old woman presenting with intermittent fever, progressive weight loss and enlarged cervical and axillary lymph nodes. Laboratory tests revealed severe Coombs' positive haemolytic anaemia, and progressive thrombocytopenia and leucopenia, associated with erythroid, myeloid and megakaryocytic hyperplasia, but with no evidence of lymphomatous infiltration in the bone marrow. Transfusion of compatible blood became possible only after prednisone therapy and a single intravenous dose of vincristine. Appropriate chemotherapy led to normalization of the peripheral blood counts and a negative direct Coombs' test.- - - - - - - - - - ranking = 5keywords = anaemia (Clic here for more details about this article) |