title: Thalassemia, extramedullary hematopoiesis, and spinal cord compression: A case report.
abstract: BACKGROUND
  Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside of the medulla of the bone. Chronic anemia states such as thalassemia can cause hematopoietic tissue to expand in certain locations. We report a case of spinal cord compression due to recurrent spinal epidural EMH, which was treated with a combination of surgery and radiotherapy. Pakistan has one of the highest incidence and prevalence of thalassemia in the world. We describe published literature on diagnosis and management of such cases.
  
  
  METHODS
  An 18-year-old male presented with bilateral lower limb paresis. He was a known case of homozygous beta thalassemia major. He had undergone surgery for spinal cord compression due to EMH 4 months prior to presentation. Symptom resolution was followed by deterioration 5 days later. He was operated again at our hospital with complete resection of the mass. He underwent local radiotherapy to prevent recurrence. At 2 years follow-up, he showed complete resolution of symptoms. Follow-up imaging demonstrated no residual mass.
  
  
  CONCLUSIONS
  The possibility of EMH should be considered in every patient with ineffective erythropoiesis as a cause of spinal cord compression. Treatment of such cases is usually done with blood transfusions, which can reduce the hematopoietic drive for EMH. Other options include surgery, hydroxyurea, radiotherapy, or a combination of these on a case to case basis.
authors.affiliation: Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Syed Sarmad
authors.initials: SS
authors.lastname: Bukhari
authors.affiliation: Department of Neurosurgery, Pakistan Navy Ship Shifa Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Junaid
authors.affiliation: Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Mamoon Ur
authors.initials: MU
authors.lastname: Rashid
keywords: Extramedullary; hematopoiesis; spinal cord compression; thalassemia