Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation.
Thrombotic microangiopathy (TMA) is a significant complication after hematopoietic stem-cell transplantation (HSCT); however, there is little information on it following reduced-intensity cord blood transplantation (RI-CBT). We reviewed the medical records of 123 adult patients who received RI-CBT at Toranomon Hospital between January 2002 and August 2004. TMA was diagnosed in seven patients based on intestinal biopsy (n = 6) or autopsy results (n = 1). While these patients showed some clinical symptoms such as diarrhea and/or abdominal pain, mental status alterations or neurological disorders were not observed in any of them. Laboratory results were mostly normal at the onset of TMA; >2% fragmented erythrocytes (n = 1), <10 mg/dl haptoglobin (n = 1), and >200 IU/dl lactic dehydrogenase (LD) (n = 4). On endoscopic examination, TMA lesions, consisting of ulcers, erosions, and diffuse exfoliation, were distributed spottily from terminal ileum to rectum. Intestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) colitis were confirmed in five and four patients, respectively. With therapeutic measures including supportive care (n = 4), fresh frozen plasma (n = 1), and a reduction of immunosuppressive agents (n = 1), TMA improved in four patients. The present study demonstrates that intestinal TMA is a significant complication after RI-CBT. Since conventional diagnostic criteria can overlook TMA, its diagnosis requires careful examination of the gastrointestinal tract using endoscopy with biopsy.
Narimatsu
H
H
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Kami
M
M
Hara
S
S
Matsumura
T
T
Miyakoshi
S
S
Kusumi
E
E
Kakugawa
Y
Y
Kishi
Y
Y
Murashige
N
N
Yuji
K
K
Masuoka
K
K
Yoneyama
A
A
Wake
A
A
Morinaga
S
S
Kanda
Y
Y
Taniguchi
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D003092:Colitis / Q000821:virology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D003586:Cytomegalovirus Infections; D005260:Female; D006086:Graft vs Host Disease; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology*; D012189:Retrospective Studies