Many translated example sentences containing “anemia hemolítica autoinmunitaria” – English-Spanish dictionary and search engine for English translations. Secundario: Neoplasias, en respuesta a una infección (Micoplasma pneumoniae) y enfermedades de colágeno. Transcript of ANEMIA HEMOLÍTICA AUTOINMUNE Anemia hemolítica idiopática autoinmunitaria: formación de anticuerpos destructores de.
|Genre:||Health and Food|
|Published (Last):||18 May 2018|
|PDF File Size:||17.3 Mb|
|ePub File Size:||16.79 Mb|
|Price:||Free* [*Free Regsitration Required]|
This paper presents the case of an 11 year-old male who attended the Internal Medicine Service at a high complexity pediatric hospital. Initially, the patient attended due to a clinical profile consisting of autoimmune hemolytic anemia that was partially responsive to steroid treatment and, after exhaustive complimentary analysis, was associated to a Hodgkin lymphoma.
Similar cases found in the scientific literature were reviewed in order to analyze this case. Through this paper, the authors intend to remind the medical community about the importance of a prompt and deep study of all autoimmune hemolytic anemia cases found in pediatric patients, without overlooking possible malignant causes related to this condition such as a lymphoproliferative disorder. Thus, before diagnosing a hemolytic anemia as idiopathic, the practitioner must be certain that the condition is not a clinical manifestation of an underlying disease.
Revista de la Facultad de Medicina
Autoimmune hemolytic anemia AHA is a relatively rare disease with an annual incidence of 1 per 75 to 80 people. Idioppatica average age of diagnosis is 3. Therefore, all patients with AHA should be studied to discover the cause and to discard the presence of neoplastic based entities such as HD and non-neoplastic entities such as infections, autoimmune diseases, drug intake, etc.
The development of autoimmune hemolytic anemia in lymphoproliferative disorders is multifactorial and caused by disorders in regulatory and autoreactive LB and LT 6 cells.
The Hodgkin lymphoma implies alterations in the immune system, which include abnormalities in the cytokine production and increased sensitivity to regulatory T cells, but with an overall decrease in the number and functional capacity of T cells Thus, during a decrease of cytotoxic T lymphocytes, an increase in autoantibody production may occur; this is currently the most accepted mechanism to explain the appearance of AHA in some of these patients 9.
In the past, based on epidemiological studies, the hypothesis of a possible infectious etiology during HD that instigates the production of antibodies that cross-react with antigens in the erythrocyte membrane 10,11 was proposed, however, this theory has not been proven yet.
This paper describes the case of a pediatric patient who developed hemolytic anemia as an initial manifestation of Hodgkin lymphoma; this finding is highlighted as a paraneoplastic manifestation of HD that should be taken into account when studying the causes of AHA. Male patient, 11 years old, with a history of anemia of 10 months which was diagnosed in a control consultation, with unclear characteristics and etiology, and managed with ferrous sulfate.
Physical examination showed a thin aspect and muco-cutaneous pallor. A complete blood count found hemoglobin at 7. The fever and weight loss manifestations suggested a neoplasm as the cause of the immune hemolytic anemia; therefore, further studies, such as chest radiography and abdominal ultrasound, were performed. The first exam showed no alterations and the second showed para-aortic lymphadenopathy and left iliac chain, as well as hypo-echoic images in the common left iliac artery.
A biopsy and bone marrow aspiration were also performed, which reported no tumor infiltration. The studies initially performed to find a possible infectious, tumor and autoimmune disease causes were negative. The patient autionmune with spiking fevers and presented painful hepatomegaly during the clinical evolution, so a new abdominal ultrasound was requested, in which enlarged lymph nodes in the para-aortic region with involvement of the left iliac region were found.
The child was further evaluated through pediatric surgery for aytoinmune node biopsy; the pediatric surgeon ordered complementary studies including an abdominal computed tomography scan that reported lymphadenopathies in the left iliac chain with ipsilateral para-aortic region involvement. Based on these findings, a magnetic resonance imaging of the abdomen and pelvis was ordered, which showed splenomegaly, nodes in the para-aortic region, left infrarenal aortoiliac bifurcation and solid smooth masses accompanying the major vessels and the lower region of the renal hilum, compatible with neoplasia.
A biopsy of the retroperitoneal lymph node showed infiltration of Reed Stemberg cells with positive reactivity in immunohistochemistry for CD15, CD30, PAX-5 and LMP-1 studies, which confirmed the diagnosis of a mixed cellularity Hodgkin disease.
The patient received six cycles of ABVD chemotherapy doxorubicin, bleomycin, vinblastine and dacarbazine autoinmube subsequent consolidation treatment with radiotherapy in sites involved at diagnosis.
At the end of the study, the child was hemolitiva clinical remission for two years, with control blood counts within normal limits, and monitoring and control through the oncohematology service. However, this type of anemia as the first manifestation of this disease is even more unusual than their mere association 10, The secondary AHA, besides presenting the characteristic clinic of hemolytic anemia such as dyspnea, fatigue, paleness or jaundice, among others, are presented along with the underlying disease clinic.
In the case of a lymphoproliferative syndrome, associated manifestations usually include appetite and weight loss, night sweats, lymphadenopathy and hepatosplenomegaly; this clinic is important because it directs or allows suspecting a neoplastic entity 6,14,16as in this patient.
Moreover, even in the absence of clinical manifestations suggestive of a lymphoproliferative syndrome as the cause of autoimmune hemolytic anemia, this type of pathologies should always be sought once the diagnosis is made, as well as other possible causes Table 1 16, A positive Coombs test can be an indicator to suspect possible relapses in patients with a history of HD in remission with or without AHA 6, Currently, there are no studies of sufficient quality to establish appropriate protocols for the management of AHA, nor a consensus on what complete remission or partial remission of the disease means 19therefore, the management of hemolytic autoimmune anemia is based on experience and individual clinical decisions.
It should be noted that the effectiveness of therapies for AHA is low when it is secondary to an underlying disease, this being especially true for autoimmune hemolytic anemias secondary to lymphoproliferative syndromes 6, The above statement was evident in the case reported here, in which no adequate response to treatment with corticosteroids was obtained. The underlying cause of AHA must always be sought, even if it is refractory to treatment.
Additionally, if there is an AHA in a patient with a history of HD in remission, HD should be suspected and a relapse should be discarded. Teresa Adriana Linares Ballesteros and Dr. Lina Eugenia Jaramillo Barberi for their valuable collaboration in the review of this document and Dr.
Autoimmune hemolytic anemia and Hodgkin disease. The cellular biology of the Reed-Sternberg cell. Immune thrombocytopenia and hemolytic anemia associated with Hodgkin ajtoinmune. Valent P, Lechner K. Diagnosis and treatment of autoimmune haemolytic anaemias in adults: How I treat autoimmune hemolytic anemias in adults.
Anemia Hemolítica Autoinmune por by Dany Lopez Castillo on Prezi
Universidad Nacional de Colombia. Reporte de caso Received: Abstract This paper presents the case of an 11 year-old male who attended the Internal Medicine Service at a jemolitica complexity pediatric hospital. Introduction Autoimmune hemolytic anemia AHA is a relatively rare disease with an annual incidence of 1 per 75 to 80 people.
Case presentation Male patient, 11 years old, with a history of anemia of 10 months which was diagnosed in a control consultation, with unclear characteristics and etiology, and managed with ferrous sulfate. Own elaboration based on Conflicts of interest None stated by the authors.
Funding None autoinmjne by the authors.