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AL-Ansari RY, Khuraim AAL, Abdalla L, Hamid H, Zakary N. Remsima (a Tumor Necrosis Factor (TNF) -α Inhibitor) induced hemolysis in a patient with Crohn's disease - Case report. Ann Med Surg (Lond) 2021; 69:102768. [PMID: 34484733 PMCID: PMC8403549 DOI: 10.1016/j.amsu.2021.102768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Crohn's disease (CD) is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. Infliximab is a treatment modality for fistulated Crohn's disease. Infliximab induced hemolysis is rare and very few cases reported before in Ulcerative colitis (UC) but not in Crohn's disease. Case presentation We are reporting a 63 years old gentleman who was diagnosed as Crohn's disease and started on Tumor necrosis factor Inhibitor (TNF) -α i.e. (infliximab - Remsima) infusion. The course was complicated by Coomb's negative hemolytic anemia which is suggestive of non-immune drug induced hemolysis. Our patient was treated with steroid and conservative measures. Upon following up, his hemoglobin level as well as all hemolytic markers showed dramatic improvement. Adalimumab was used to treat this patient as an alternative choice without relapse of hemolysis. Clinical discussion Drug induced Hemolysis is not a well-known complication post receiving Tumor necrosis factor Inhibitor (TNF) -α infusion in patients with Crohn's disease. Coombs negative hemolysis keeps in favor of non-immune drug induced rather than other differentials in our case scenario. Conclusion Although cross-reactivity is expected between one biological agent to another, in our case the use of Adalimumab as alternative choice post Tumor necrosis factor Inhibitor (TNF) -α (Remsima infliximab) induced hemolysis did not cause hemolysis or any type of reaction.
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Affiliation(s)
- Rehab Y. AL-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, 31932, Saudi Arabia
- Corresponding author.
| | - Arwa AL. Khuraim
- Internal Medicine Department, KFMMC, Dhahran, 31932, Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, 31932, Saudi Arabia
| | - Hind Hamid
- Gastroenterology Unit, Internal Medicine Department, KFMMC, Dhahran, 31932, Saudi Arabia
| | - N.Y. Zakary
- Gastroenterology Unit, Internal Medicine Department, KFMMC, Dhahran, 31932, Saudi Arabia
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Al-Ansari RY, Al Otaibi D, Al Hudaithi N, Abdalla L. Isolated ten-eleven translocation 2 positive in triple negative essential thrombocythemia: Case report and literature review. SAGE Open Med Case Rep 2021; 9:2050313X211032066. [PMID: 34350001 PMCID: PMC8287412 DOI: 10.1177/2050313x211032066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Essential thrombocythemia is one of the famous diseases under the category of
myeloproliferative disorder. It is an end result of a genetic mutation of one or more of
the most frequent oncogenes such as Janos kinase 2 (JAK2), MPL proto-oncogene,
thrombopoietin receptor (MPL), and calreticulin (CALR). However, negative genetic markers,
so-called (triple negative disease), can happen in the presence of other uncommon types of
mutation. TET2 (ten-eleven translocation 2) positive as isolated genetic marker in triple
negative essential thrombocythemia is uncommon genetic presentation. For that, we are
reporting a 22-year-old lady who presented with a feature of dyspepsia and accidentally
found to have persistently high platelet count, even after treating her mild iron
deficiency anemia with no other secondary causes. Further investigations and bone marrow
biopsy supported the diagnosis of isolated TET2 positive in triple negative essential
thrombocythemia. We treated her conservatively with good hydration and low dose of
aspirin. In conclusion, isolated TET2 positive in triple negative essential
thrombocythemia at presentation is uncommon with no clear management or risk
stratification guideline. However, it is hypothesized that TET2 mutation
precedes JAK2; therefore, the detection of isolated TET2 in a triple
negative essential thrombocythemia case should be closely followed for clonal evolution in
long term. Further study and guidelines required in this area.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Dena Al Otaibi
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Nourah Al Hudaithi
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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Alromaih L, Abdalla L, Jamal A, Osman A, Bakkar M, Samad LA, Ahmed TM. Chronic Neutrophilic Leukemia with Monocytosis. Eur J Case Rep Intern Med 2021; 8:002595. [PMID: 34123950 DOI: 10.12890/2021_002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic neutrophilic leukaemia is a very rare disease with diagnosis based on persistent leucocytosis >25×103/μl and monocytes <1×103/μl. The revised WHO criteria 2016 included CSF3R gene mutations as a diagnostic finding. We report the case of a 77-year-old man who was found to have asymptomatic persistent mature neutrophilic leucocytosis with monocytosis. Molecular study confirmed the presence of a CSF3R gene mutation in the absence of morphological or genetic features of myelodysplasia or other forms of myelodysplastic syndrome. The patient's medical history was significant for coronary artery disease, hypertension, chronic obstructive pulmonary disease, bilateral cystic bronchiectasis, moderate pulmonary hypertension, tuberculosis treated 27 years previously, hypothyroidism, and a thyroid nodule. He had hepatosplenomegaly but no lymphadenopathy, and no other malignancy was seen on computed tomography (CT) scanning. At the time of evaluation, he was free of symptoms and had no evidence of infection or drug-induced leucocytosis. The patient was referred to an oncology centre and treated with hydroxyurea and subsequently azacitidine. However, he developed pancytopenia with bone marrow aplasia. He died with neutropenia sepsis. The presence of persistent monocytosis in this case created a diagnostic dilemma as to whether the disease was a variant of chronic neutrophilic leukaemia or was reactive monocytosis. LEARNING POINTS The presence of a CSF3R gene mutation is diagnostic for chronic neutrophilic leukaemia (CNL).The monocytosis in this patient might have been a new variant of CNL.
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Affiliation(s)
- Laila Alromaih
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Arifa Jamal
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Assim Osman
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Mohanad Bakkar
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Lina Abdul Samad
- Radiology Department, Nuclear medicine division, KFMMC Dhahran, Kingdom of Saudi Arabia
| | - Tamer M Ahmed
- Clinical Hematology and Internal Medicine, Ain Shams University, Cairo, Egypt
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Al-Ansari RY, Alshaer A, Al-Anazi A, Al-Otaibi N, Abdalla L, Al-Tarrah S, Shilash A, Al-Zahrani N. ABO in Correlation to the Requirement of Mechanical Ventilation and Mortality in Critically Ill Patients With COVID-19. J Hematol 2021; 10:64-70. [PMID: 34007367 PMCID: PMC8110225 DOI: 10.14740/jh821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that was first discovered in December 2019 and turned to be pandemic in early March 2020. We aimed to describe the dominant ABO group and outcomes of critically ill patients (respiratory failure requiring mechanical ventilation and mortality) in a Saudi Arabian setting. Methods We conducted an observational, analytic cross-sectional, retrospective study in a tertiary care hospital. Around 90 candidates tested positive for COVID-19 were enrolled in this study during admission to critical care unit between May 2020 and September 2020. Blood group was detected in all patients included in the study during admission to critical care unit. Results In this study, data of 90 patients with COVID-19 admitted to critical care unit were collected. Some prevalent medical conditions were collected, in which hypertension (64.2%) and diabetes mellitus (58.9%) were the most reported comorbidities among patients and there was no significant difference between groups. Most of the sample had blood group of O (45.6%), while the least group was AB (5.6%). Patients with blood group of A/AB showed the highest mortality vs. group O/B (32% vs. 18.5%) with significant P value of 0.001. Patients of groups A/AB had higher risk for intubation than O/B groups (52.0% and 49.2%, respectively; confidence interval of 0.44 - 2.8 with insignificant P value of 0.055). Length of stay in critical care unit was significantly higher in group A/AB with a mean course of 18.20 days in comparison to group O/B with a mean course of 12.63 days (P = 0.033). Conclusion Our data indicate that critically ill patients with COVID-19 with blood group A/AB are at increased risk of mortality and length of stay in critical care unit, with insignificant requirement of mechanical ventilation when compared with patients with blood group O/B. Future larger studies are needed to validate and understand the underlying mechanisms.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | | | - Aamer Al-Anazi
- Laboratory Department-Blood Bank, KFMMC, Dhahran 31932, Saudi Arabia
| | - Nasser Al-Otaibi
- Laboratory Department-Blood Bank, KFMMC, Dhahran 31932, Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Sufana Al-Tarrah
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Amal Shilash
- Infection Control Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Nada Al-Zahrani
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
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Al-Ansari RY, Bakkar M, Abdalla L, Sewify K. Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura. Eur J Case Rep Intern Med 2020; 7:002143. [PMID: 33457377 DOI: 10.12890/2020_002143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 11/05/2022] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP. Case description A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient's general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized. Conclusion TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called 'TTP resembling presentation') is an area of further research. LEARNING POINTS COVID-19 can manifest as a picture of thrombotic thrombocytopenic purpura (TTP) which requires therapeutic plasma exchange as in other cases of TTP.Further research is required on the use of therapeutic plasma exchange in severe COVID-19 with cytokine storm.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Mohanad Bakkar
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Khaled Sewify
- Critical Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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Al-Ansari RY, Al Harbi M, Al-Jubair N, Abdalla L. Acute Soft Head Syndrome (Subgaleal Haematoma) with Periorbital Oedema as a Rare Presentation in Sickle Cell Disease. Eur J Case Rep Intern Med 2020; 7:001766. [PMID: 33083354 DOI: 10.12890/2020_001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background Sickle cell disease is a genetic condition frequently found in Africa and the Arabian Peninsula. Uncommon complications include subgaleal haematoma (soft head syndrome) and periorbital oedema. Case presentation A 17-year-old male patient presented with body aches and progressive right parieto-temporal and frontal head swelling. Physical examination revealed puffiness of the right eye that progressed rapidly to reddish periorbital oedema sparing the extraocular muscle and pupil response to light. CT and MRI of the brain suggested multiple subgaleal haematomas (soft head syndrome) and right periorbital oedema. Conclusion Subgaleal haematoma (soft head syndrome) and periorbital oedema are uncommon complications of sickle cell disease. Management is conservative rather than surgical. LEARNING POINTS Subgaleal haematoma concurrently with periorbital oedema is a rare presentation of sickle cell disease.There are no guidelines on treatment, but the conditions in our patient resolved with conservative management.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Maan Al Harbi
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Nawaf Al-Jubair
- Neuroradiology unit, Radiology Department, KFMMC, Dhahra, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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Campos S, Samano M, Pego-Fernandes P, Teixeira R, Carraro R, Afonso-Junior J, Costa A, Machado C, Souza A, Pereira B, Fernandes L, Abdalla L. Clinical Assessment of Cytomegalovirus Specific Cell Mediated Immunity in a Prospective Cohort of Lung Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Campos S, Almeida Jr J, Samano M, Carraro R, Costa A, Teixeira R, Afonso-Jr J, Camargo P, Abdalla L, Fernandes L, Pêgo-Fernandes P. Trichosporon Infection in Lung Transplant Patients: An Emerging Fungal Infection? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Barra G, Caixeta M, Santa Rita T, Chianca C, Velasco L, Almeida P, Vivas W, Abdalla L, Costa S. HPV infection pattern and genotype distribution in cervical cytology and in penile lesion biopsies. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ahmed NE, Abdalla L. Some physical measurements and haematological studies in the Sudanese newborn baby. J Trop Med Hyg 1967; 70:271-4. [PMID: 6060256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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