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Autoimmune pancytopenia occurring late after simultaneous pancreas and kidney transplantation
- Source :
- BMJ Case Rep
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
- Subjects :
- Adult
medicine.medical_specialty
Time Factors
Pancytopenia
medicine.medical_treatment
Gastroenterology
Autoimmune Diseases
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Internal medicine
medicine
Humans
Kidney transplantation
Romiplostim
business.industry
Immunosuppression
General Medicine
Petechial rash
medicine.disease
Kidney Transplantation
Tacrolimus
030220 oncology & carcinogenesis
Absolute neutrophil count
Female
Rituximab
Pancreas Transplantation
business
030217 neurology & neurosurgery
New Disease
medicine.drug
Subjects
Details
- ISSN :
- 1757790X
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- BMJ Case Reports
- Accession number :
- edsair.doi.dedup.....b93c7c71b79092d5aab0b74db0d996c0
- Full Text :
- https://doi.org/10.1136/bcr-2020-235851