[Bone marrow aplasia during hemodialysis successfully treated with cyclosporine. Report of one case].
A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16%, white blood cell count 3,800 mm3 and platelets 11,000 mm3. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43%, white blood cell count 6,600 mm3 and platelets, 150,000 mm3 and did not change during the first year of follow up.
Servicio de Medicina Interna, Secciones de Nefrología, Hospital Naval Almirante Nef, Viña del Mar. jvegastieb@hotmail.com
Jorge
J
Vega
María de los Angeles
Mde L
Rodríguez
Alejandro
A
Vásquez
Carlos
C
Torres
D000328:Adult; D000741:Anemia, Aplastic / Q000188:drug therapy* / Q000209:etiology; D016572:Cyclosporine / Q000627:therapeutic use*; D005922:Glomerulonephritis, IGA / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D010198:Pancytopenia / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects
D007166:Immunosuppressive Agents; D016572:Cyclosporine