Distribution of Pathology-Driven Algorithmic Testing Cases (a) Patients on Patients on Malignant Track Each Track 2 Tracks Diagnosis PSRs Acute leukemia 26 0 26 25 Treated acute leukemia 66 1 0 0
Cytopenias 58 10 18 9 CML 3 0 3 2 MPN 39 0 29 19 Plasma cell dyscrasia 46 3 34 21 Lymphoma 89 5 42 9 Other 7 1 0 0 Total 334 10 (b) 152 85 New PSRs on Malignant New Diagnoses, Track Diagnosis No.
Hepatosplenomegaly and
cytopenias were observed in all cases with ensuing severe opportunistic infections leading to death of these three patients.
Cytopenia of erythrocytes, platelets, or neutrophils are common in both MAS and HLH (Table) (13).
Other
cytopenias were also noticed particularly thrombocytopenia.
The patient met diagnostic criteria for HLH, including fever, splenomegaly,
cytopenia, hypertriglyceridemia, hypofibrinogenemia, hemophagocytosis in bone marrow, and elevated ferritin.
Bone marrow involvement causes suppression of normal hematopoiesis and consequent peripheral
cytopenias, in our study there was a statistically significant difference in frequency of leucopenia and thrombocytopenia in cases with and without marrow infiltration (table 1) pancytopenia was found in 7 cases (16.6%) with marrow infiltrates in contrast to 1 (2.4%) case with uninvolved marrow.
Myelodysplastic syndrome (MDS) is a heterogeneous group of diseases, caused by clonal stem cell disorders, with the specific sign of peripheral
cytopenia due to ineffective hemopoiesis with normal or increased cellularity of the bone marrow.
Given that
cytopenias are commonly reported in rituximab usage, transplant physicians have to be extra vigilant in monitoring the different lineages of blood, especially 4 weeks post-rituximab administration.
Hence, it is possible that
cytopenias in patients with CLDs, in part, could be attributed to fecal dysbiosis induced by antimicrobial therapy.
Hemophagocytic lymphohistiocytosis (HLH) is a rare, hyperinflammatory syndrome characterized by
cytopenias with fevers, chills, malaise, myalgias, and diaphoresis with high morbidity and mortality [1].
Laboratory investigations before discharge showed resolution of the
cytopenias, down trending of liver function tests and triglycerides levels, and ferritin was still elevated.
MTX, azathioprine (AZA), MMF, cyclosporine, and other calcineurin inhibitors should be considered in cases of arthritis, cutaneous disease, serositis, vasculitis, or
cytopenias if HCQ is insufficient.