Hepatic manifestation of hemolytic uremic syndrome in an allogeneic bone marrow transplant recipient.
A 33-year-old woman presented 42 days after allogeneic bone marrow transplantation for acute monocytic leukemia (AML, FAB M5) with persistent thrombocytopenia, acute renal failure and Coombs negative hemolytic anemia. In the absence of the disseminated intravascular coagulation the diagnosis of hemolytic uremic syndrome due to immunosuppression with cyclosporin A was supposed. Because cessation of cyclosporin A and therapeutic infusions of fresh frozen plasma had failed, plasmaseparation therapy was started on day 79 after bone marrow transplantation. While hemolytic anemia improved during ongoing plasmaseparations the patient developed cholestatic liver failure due to hepatic manifestation of HUS. The histological lesions of liver involvement in thrombotic microangiopathies are discussed and a review of the literature is presented.
Böcher
W O
WO
Department of Internal Medicine, Hospital of the Johannes Gutenberg University Mainz, Germany.
Schirmacher
P
P
Löhr
H F
HF
Kolbe
K
K
Wanitschke
R
R
Meyer zum Büschenfelde
K H
KH
D000328:Adult; D000743:Anemia, Hemolytic / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000473:pathology; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007948:Leukemia, Monocytic, Acute / Q000473:pathology / Q000628:therapy*; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017093:Liver Failure / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D008111:Liver Function Tests; D010956:Plasmapheresis; D014184:Transplantation, Homologous