Microangiopathic hemolytic anemia in a graft-versus-host disease patient treated with cyclosporine A and prednisolone.
A 38-year-old male patient with chronic myelocytic leukemia in the first chronic phase underwent bone marrow transplantation (BMT) from an HLA identical sibling. He developed chronic graft-versus-host disease and his condition gradually deteriorated. Fourteen months after BMT, acute progressive anemia, thrombocytopenia, reticulocytosis, increased serum lactic dehydrogenase and increased serum bilirubin were revealed following treatment with cyclosporine A (240 mg/day i.v.), prednisolone (60 mg/day i.v.) and azathioprine (100 mg/day p.o.). Red blood cell fragmentations were also found microscopically. At that time, the serum cyclosporine A trough level was 1,300 ng/ml by the polyclonal antibody RIA method. These symptoms were resolved by discontinuation of cyclosporine A and administrations of aspirin, cilostazol, and dipyridamole as anti-platelet agents. We consider this phenomenon to be micro-angiopathic hemolytic anemia due to a serum high cyclosporine A level which resulted from the concomitant use of cyclosporine A with prednisolone.
Hatta
Y
Y
First Department of Internal Medicine, School of Medicine, Nihon University, Tokyo.
Tomura
K
K
Kawamura
M
M
Itoh
T
T
Baba
M
M
Horie
T
T
D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects* / Q000097:blood; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000009:adverse effects*
D016572:Cyclosporine; D011239:Prednisolone