title: A Hispanic female patient with heartburn: A rare presentation of Paroxysmal Nocturnal Hemoglobinuria.
abstract: Paroxysmal nocturnal hemoglobinuria (PNH) is a non-malignant, acquired clonal hematopoietic stem cell disease that can present with bone marrow failure, hemolytic anemia, smooth muscle dystonias, and thrombosis. We present a case of a 32 year-old-female, G2P2A0 with no past medical history of any systemic illnesses who refers approximately 2 months of progressively worsening constant heartburn with associated abdominal discomfort. CBC showed leukopenia (WBC 2.9 x 103 /µL) with neutropenia (segmented neutrophils 48%), macrocytic anemia (Hgb 6.1 g/dL, hematocrit 20%, MCV,113 fL) and thrombocytopenia (platelet count 59 x 109/L). Abdomino-pelvic CT scan revealed a superior mesenterc vein thrombosis, which was treated initially with low-molecular-weight heparih for full anticoagulation. Peripheral blood flow cytometry assays revealed diminished expression of CD55 and CD59 on the erythrocytes, granulocytes and monocytes.' Paroxysmal nocturnal hemoglobinuria is a rare, clonal, hematopoietic stem-cell disorder whose manifestations are almost entirely explained by complement-mediated intravascular hemolysis. The natural history of PNH is highly variable, ranging from indolent to life-threatening. The median survival is 10 to 15 years, but with a wide range. Thrombosis is the leading cause of death, but others may die of complications of bone marrow failure, renal failure, myelodysplastic syndrome, and leukemia. Anticoagulation is only partially effective in preventing thrombosis in PNH; thus, thrombosis is an absolute indication for initiating treatment with Eculizumab. Nevertheless, bone marrow transplantation (BMT) is still the only curative therapy for PNH but is associated with significant morbidity and mortality.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Figueroa-Jiménez
authors.forename: Amy Lee
authors.initials: AL
authors.lastname: González-Márquez
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alicea-Guevara
authors.forename: Mónica
authors.initials: M
authors.lastname: Santiago-Casiano
authors.forename: Maryknoll
authors.initials: M
authors.lastname: de la Paz-López
authors.forename: Luis
authors.initials: L
authors.lastname: Negrón-Garcia
authors.forename: Luis
authors.initials: L
authors.lastname: Báez-Diaz
authors.forename: William
authors.initials: W
authors.lastname: Cáceres-Pérkins
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D005221:Fatigue / Q000209:etiology; D005260:Female; D017261:Glycosylphosphatidylinositols / Q000172:deficiency; D006356:Heartburn / Q000209:etiology*; D006456:Hemoglobinuria / Q000209:etiology; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications / Q000175:diagnosis*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D010198:Pancytopenia / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D017261:Glycosylphosphatidylinositols; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; C481642:eculizumab