Bone Marrow Transplantation for Aplastic Anemia Following Hepatitis

Abstract

The fatal outcome of aplastic anemia following hepatitis is well documented. Therefore bone marrow (BM) transplantation was performed in a 12-year-old girl who developed pancytopenia following mild hepatitis. Repeated BN aspirations revealed absent megakaryocytes, and erythroid and mycloid precursors. Despite prednisolone and oxymethylone therapy the pancytopenia progressed and oxymethylone therapy the pancytopenia progressed (hg 6.4%, WBC 100/mm3, platelets 10,000/mm3). Staphylococcal sepsis following a finger infection and gram-negative sepsis following a perirectal abscess were treated with multiple antibiotics. Thawed frozen red cell and platelet transfusions were given as required. Because the clinical course was one of progressive deterioration without evidence of BM regeneration, BM transplantation was performed. The patient was pretreated with transperformed. The patient was pretreated with transfused donor buffy coat cells followed by cyclophosphamide 60 mg/kg for 3 days. 505 ml of HLA matched BM from an uncle were given. On the 8–10th day following transplantation reticulocytes were seen and the WBC rose to 2,200/mm3. BM revealed megakaryocytes and clusters of mycloid and crythroid cells. Chromosomal analysis revealed XY pattern. Concurrently the patient developed periodbital edema and desquamating erythematous rash, purpura, abdominal pain, gross bleeding from the bowel and low factors II, V, VII and VIII with elevated factor I suggesting a consumption coagulopathy. She died 10 days following BM transplantation. Postmortem revealed regenerating marrow and extensive plasmacytoid cell proliferation in lymph nodes, spleen, lungs and skin consistent with graft versus host syndrome. A successful marrow graft in posthepatitis aplasia can be achieved.

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Hilgartner, M., Lanzkowsky, P., Nachman, R. et al. Bone Marrow Transplantation for Aplastic Anemia Following Hepatitis. Pediatr Res 4, 468–469 (1970). https://doi.org/10.1203/00006450-197009000-00137

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