1
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Guizzetti L. Temporal trends of splenectomy in pediatric hospitalizations with hereditary spherocytosis from 2000 to 2019: A national survey. Pediatr Blood Cancer 2024; 71:e30869. [PMID: 38316689 DOI: 10.1002/pbc.30869] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Total and partial splenectomy are used in pediatric patients with hereditary spherocytosis to resolve anemia and hemolytic complications. PROCEDURE Data from the Healthcare Cost and Utilization Project's Kid's Inpatient Database was used to profile and describe temporal trends in pediatric (≤18 years) hospital admissions in the United States from 2000 to 2019 data release years. Survey sampling methods were used to produce national estimates. RESULTS From 2000 to 2019, the use of splenectomy declined overall, from 427 to 206 weighted procedures (difference = 222, 95% confidence interval [CI]: 124-320; p < .0001); the risk of undergoing splenectomy during admission also declined from 56.7% to 38.7% (risk difference = 17.9 percentage points [p.p.], 95% CI: 9.7-26.1; p < .0001). Total splenectomy was mostly used. Age at time of splenectomy increased 10.2 years (difference = 1.6 years, 95% CI: 0.6-2.7; p = .0018). The risk of splenectomy increased with age until 10 years, then leveled off until 18 years. The proportion of children aged ≤5 years undergoing splenectomy decreased from 27.7% to 11.2% in 2019 (risk difference: 16.5 p.p., 95% CI: 7.3-25.7; p = .0004). The strongest clinical predictors of splenectomy, adjusting for patient- and hospital-level characteristics, were a co-diagnosis of symptomatic cholelithiasis (adjusted odds ratio [aOR] = 3.18, 95% CI: 1.92-5.28; p < .0001) and splenomegaly or hypersplenism (aOR = 2.52, 95% CI: 1.74-3.65; p < .0001). Risk of splenectomy with splenomegaly or hypersplenism increased over time. CONCLUSION Splenectomy was delayed until age greater than 10 years. Older age, co-diagnosis with splenomegaly or hypersplenism, or symptomatic cholelithiasis were strongest clinical predictors of splenectomy. Conservative management of hereditary spherocytosis appears to be more common.
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Soldin IH, Ferro A, Eremina YO, Bibi MSN. Coinheritance of hereditary spherocytosis with haemochromatosis: next-generation sequencing reveals. BMJ Case Rep 2024; 17:e256891. [PMID: 38195192 PMCID: PMC10806931 DOI: 10.1136/bcr-2023-256891] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
We report the case of a man in his 50s with extravascular haemolysis, fluctuating indirect hyperbilirubinaemia, elevated transferrin saturation with hyperferritinaemia and normal liver enzymes. Spherocytes were detected in a blood smear and a mutation of unknown significance, c.1626+1G>A p.?, in intron 13 of the SLC4A1 gene, was identified by next-generation sequencing (NGS). The same mutation was found in his daughter, who presented with similar laboratory changes, confirming the diagnosis of hereditary spherocytosis. Abdominal MRI showed hepatosplenomegaly with hepatic iron overload. In this context of haemolysis (without anaemia) and iron overload, a diagnosis of haemochromatosis was presumed. NGS confirmed the presence of the variants p.(His63Asp) and p.(Cys282Tyr) in heterozygosity in the HFE gene. We report this case for the rarity of co-existing two haematological diseases counteracting each other.
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Affiliation(s)
- Inês Hilário Soldin
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
- Portuguese Institute of Oncology of Porto, Francisco Gentil EPE, Porto, Portugal
| | - Ana Ferro
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Yuliana O Eremina
- Clinical Pathology Department, Hospital Pedro Hispano, Matosinhos, Portugal
- University of Porto, Porto, Portugal
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3
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Daşdemir S, Kaya Z, Bento C. Peripheral Blood Smear Findings in 2 Patients With Coexisting Thalassemia and Hereditary Spherocytosis. J Pediatr Hematol Oncol 2023; 45:149-150. [PMID: 36161974 DOI: 10.1097/mph.0000000000002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sevgi Daşdemir
- Gazi University Faculty of Medicine, Pediatrics Hematology, Ankara, Turkey
| | - Zühre Kaya
- Gazi University Faculty of Medicine, Pediatrics Hematology, Ankara, Turkey
| | - Celeste Bento
- Laboratório de Hematologia Molecular Hospital, Pediatrico, Portugal
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Nato Y, Kageyama Y, Suzuki K, Shimojima Yamamoto K, Kanno H, Miyashita H. A Novel SPTA1 Mutation in a Patient with Hereditary Spherocytosis without a Family History and Coexisting Gilbert's Syndrome. Intern Med 2023; 62:107-111. [PMID: 35650129 PMCID: PMC9876709 DOI: 10.2169/internalmedicine.9478-22] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Most patients with hereditary spherocytosis (HS) have a family history of disease, while those without such a history are difficult to diagnose. We herein report a case of HS with no family history harboring a novel heterozygous mutation of SPTA1, c.2161G>A (p.E721K), and a homozygous polymorphism of UGT1A1*6. In silico analyses suggested that the mutation might contribute to the pathogenesis of HS. The coexistence of HS and Gilbert's syndrome increases the risk of gallstones. Therefore, splenectomy, alone or in combination with cholecystectomy, is recommended. The determination of genetic diathesis provides useful information for the management of hemolytic anemia.
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Affiliation(s)
- Yuma Nato
- Department of Hematology, Yokkaichi Municipal Hospital, Japan
| | - Yuki Kageyama
- Department of Hematology, Yokkaichi Municipal Hospital, Japan
| | - Kazutaka Suzuki
- Department of Hematology, Yokkaichi Municipal Hospital, Japan
| | | | - Hitoshi Kanno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University, Japan
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Giovanni Raimondo P, Ilaria P, Andrea S, Pierangela C, Fabio P, Tommaso M, Marco Z, Enrico F. A novel SLC4A1 mutation in a child with hereditary spherocytosis and distal renal tubular acidosis. Pediatr Blood Cancer 2022; 69:e29729. [PMID: 35441494 DOI: 10.1002/pbc.29729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/13/2022] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | - Possenti Ilaria
- Pediatric and Pediatric Emergency Unit, Children Hospital, Alessandria, Italy
| | - Secco Andrea
- Pediatric and Pediatric Emergency Unit, Children Hospital, Alessandria, Italy
| | | | - Paglialonga Fabio
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Grande IRRCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Mina Tommaso
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Zecca Marco
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Felici Enrico
- Pediatric and Pediatric Emergency Unit, Children Hospital, Alessandria, Italy
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Caglar O, Delmotte P, Ketelslegers O, Radermecker RP. [When HbA1c is unreliable : a case report of hereditary spherocytosis]. Rev Med Liege 2022; 77:624-628. [PMID: 36354221] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Glycated haemoglobin (HbA1c) is a biological parameter used in the management of diabetic patients. Independent of the daytime glycaemic variations, but complementary to the measurement of blood glucose or subcutaneous glucose concentrations, it allows both the clinician and the patient to have an appreciation of the glycaemic balance of the last weeks. In this way, anti-diabetic treatment can be adjusted if necessary to achieve the desired goal and hopefully delay or prevent diabetes-related micro- and macroangiopathic complications. Some conditions can alter the glycation of haemoglobin. In this case, the HbA1c level becomes difficult to interpret. Hereditary spherocytosis may be revealed by a dissociation between low HbA1c level and high blood glucose levels. A family history, Coombs-negative haemolytic anaemia, or a finding of spherocytes in the blood smear is suggestive of hereditary spherocytosis. Fructosamine testing may be an alternative. This article will present a patient with hereditary spherocytosis in whom the HbA1c level was not interpretable when compared to the elevated blood glucose measurements.
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Affiliation(s)
- O Caglar
- Étudiant en Médecine, ULiège, Belgique
| | - P Delmotte
- Service d'Endocrino-Diabétologie, CHR de la Citadelle, Liège, Belgique
| | - O Ketelslegers
- Service de Biologie clinique, CHR de la Citadelle, Liège, Belgique
| | - R P Radermecker
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Centre Interdisciplinaire de Recherche sur le Médicament (CIRM), ULiège, Belgique
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Gibson SJ, Kalfa TA, DeStefano CB. Insane in the membrane: A case of hereditary spherocytic pyropoikilocytosis. Am J Hematol 2022; 97:1384-1385. [PMID: 35834292 DOI: 10.1002/ajh.26662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Steven J Gibson
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christin B DeStefano
- Department of Hematology/Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Zhang Y, Shao S, Liu J, Zeng C, Han Y, Zhang X. Neonatal hereditary spherocytosis caused by a de novo frameshift mutation of the SPTB gene characterized by hydrops fetalis: A case report. Medicine (Baltimore) 2021; 100:e24804. [PMID: 33761640 PMCID: PMC9282131 DOI: 10.1097/md.0000000000024804] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The etiology of non-immune hydrops fetalis is complex, and its prognosis is poor. One of its main causes is anemia. There are few reports on hydrops fetalis due to anemia caused by hereditary spherocytosis (HS), especially regarding its occurrence in the neonatal period. Thus, we report on a case of neonatal HS caused by a new SPTB gene mutation that was characterized by hydrops fetalis. PATIENT CONCERNS A neonate with intrauterine hydrops fetalis showed severe hyperbilirubinemia and anemia, reticulocytosis, and hepatosplenomegaly. Laboratory examination findings were normal. DIAGNOSES Gene sequencing of the patient and his parents showed a de novo frameshift mutation in the patient's SPTB gene. Ultimately, the patient was diagnosed with HS. INTERVENTIONS Exchange and red blood cell transfusions were performed in the neonatal period. OUTCOMES The child was discharged from the hospital 14 days postnatal because his hemoglobin and bilirubin levels were stable. Red blood cell transfusion was performed once in infancy; however, no further red blood cell transfusions were required within 2 years of age. LESSONS Hydrops fetalis can be a manifestation of HS. Genetic detection can help confirm the diagnosis of suspected neonatal HS undocumented by other laboratory examinations.
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Affiliation(s)
- Yimin Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Shuming Shao
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jie Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Chaomei Zeng
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Ye Han
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Xiaorui Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
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Meglic A, Debeljak M, Kovac J, Trampus Bakija A, Rajic V, Kojc N, Trebusak Podkrajsek K. SPTB related spherocytosis in a three-generation family presenting with kidney failure in adulthood due to co-occurrence of UMOD disease causing variant. Nefrologia 2020; 40:421-428. [PMID: 32113667 DOI: 10.1016/j.nefro.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/14/2019] [Accepted: 10/27/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hereditary spherocytosis is clinically and genetically heterogeneous disorder and its clinical characteristics are spherocytosis, anaemia, jaundice and splenomegaly. The aetiology is associated to the genes encoding proteins involved in the interaction between the erythrocyte membrane and the lipid bilayer. Causative variants in βI-spectrin (SPTB) gene presenting as mild to moderately severe disease are responsible for approximately 25% cases in the USA and Europe. Among kidney disease, isolated cases of nephrotic syndrome due to membranoproliferative glomerulonephritis and macroscopic haematuria with proteinuria due to IgA nephropathy were previously reported in patients with SPTB deficiency. OBJECTIVE Seven patients from the same family with spherocytosis were evaluated to assess the kidney failure presented in all affected adult patients. METHODS Clinical, radiological and laboratory investigations were issued to evaluate the spherocytosis and kidney disease. In selected patients, we also performed genetics testing with next generation sequencing of genes related to hereditary spherocytosis, inherited glomerular disorders and tubulo-interstitial kidney disease. RESULTS Among the family members with spherocytosis, two adults had end-stage kidney disease and one chronic kidney disease stage 4 with unspecific histopathological findings of interstitial fibrosis/tubular atrophy and glomerulosclerosis. At the time, there were no signs of kidney disease present in four paediatric patients. Novel nonsense variant in SPTB gene (NM_001024858; c.4796G>A; p.Trp1599Ter) was detected in all family members with spherocytosis and was predicted to be disease causing. Furthermore, all adult patients with kidney failure and two paediatric cousins of the index patients were heterozygous for the UMOD gene variant (NM_003361.3:c.552G>C, NP_003352.2:p.Trp184Cys) previously reported in patients with tubulo-interstitial kidney disease. UMOD variant was not present in the index patients. CONCLUSIONS The co-occurrence of any two rare inherited disorders is extremely rare, while to our knowledge the co-occurrence of genetically confirmed HS and autosomal dominant tubulo-interstitial kidney disease (ADTKD) has previously not been reported. It is not possibly to evaluate whether the haemolytic crises due to HS are influencing the progression of the UMOD related renal disease, since the UMOD related ADTKD characteristics in general and in here presented family are extremely variable. Nevertheless, the observed kidney disease in the family is warranting the regular nephrological examinations in UMOD positive paediatric patients in the family in order to recognise hyperuricemia and treat it as early as possible. This is emphasising the importance of serum uric acid detection in routine laboratory screening of paediatric patients in order to identify early signs of tubular injury indicating possible ADTKD.
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Affiliation(s)
- Anamarija Meglic
- University Medical Centre Ljubljana, University Children's Hospital, Department of Nephrology, Ljubljana, Slovenia
| | - Marusa Debeljak
- University Medical Centre Ljubljana, University Children's Hospital, Institute for Special Laboratory Diagnostics, Ljubljana, Slovenia
| | - Jernej Kovac
- University Medical Centre Ljubljana, University Children's Hospital, Institute for Special Laboratory Diagnostics, Ljubljana, Slovenia
| | - Alenka Trampus Bakija
- University Medical Centre Ljubljana, University Children's Hospital, Institute for Special Laboratory Diagnostics, Ljubljana, Slovenia
| | - Vladan Rajic
- University Medical Centre Ljubljana, University Children's Hospital, Department of Haematology and Oncology, Ljubljana, Slovenia
| | - Nika Kojc
- University of Ljubljana, Faculty of Medicine, Institute of Pathology, Ljubljana, Slovenia
| | - Katarina Trebusak Podkrajsek
- University Medical Centre Ljubljana, University Children's Hospital, Institute for Special Laboratory Diagnostics, Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Ljubljana, Slovenia.
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10
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Qian J, Shen Q, Yin H, Shi WY, Yang L, Zhang YP, Liu H. Development of myelofibrosis and acute monocytic leukemia in a patient with hereditary spherocytosis: A case report. Medicine (Baltimore) 2019; 98:e18266. [PMID: 31852097 PMCID: PMC6922592 DOI: 10.1097/md.0000000000018266] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Common symptoms of hereditary spherocytosis (HS) include intermittent jaundice and splenomegaly. Here, we present an unusual clinical course wherein a patient with HS treated with splenectomy developed secondary myelofibrosis and acute monocytic leukemia (M5). PATIENT CONCERNS After presenting with paleness, fatigue and jaundice, the patient was diagnosed with HS. After splenectomy, follow-up testing, including bone marrow biopsy, revealed myelofibrosis. Subsequently, the patient exhibited blood cell abnormalities consistent with M5. DIAGNOSIS M5 comorbid with myelofibrosis and a history of HS. INTERVENTIONS HS was treated with splenectomy. Myelofibrosis was treated with hydroxyurea. The patient refused chemotherapy for M5 and was discharged. He was maintained on hydroxyurea and received periodic blood product transfusions with regular routine blood test monitoring. OUTCOMES Because of intracranial hemorrhage, the patient died on May 17, 2018, a little >10 months after being diagnosed with leukemia. CONCLUSION The present patient developed M5 while undergoing treatment for myelofibrosis and after undergoing splenectomy for HS, raising the question of whether these conditions might be associated. Examination of this question will require the analysis of additional cases.
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Affiliation(s)
- Juan Qian
- Department of Hematology, Affiliated Hospital of Nantong University
| | - Qian Shen
- Department of Oncology, Nantong Oncology Hospital, Nantong, Jiangsu, China
| | - Hong Yin
- Department of Hematology, Affiliated Hospital of Nantong University
| | - Wen-yu Shi
- Department of Hematology, Affiliated Hospital of Nantong University
| | - Li Yang
- Department of Hematology, Affiliated Hospital of Nantong University
| | - Ya-ping Zhang
- Department of Hematology, Affiliated Hospital of Nantong University
| | - Hong Liu
- Department of Hematology, Affiliated Hospital of Nantong University
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Abstract
We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.
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Affiliation(s)
- Emily Finan
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Joe Joseph
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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Affiliation(s)
- T Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi, Japan
| | - O Ichii
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Kita-Ku, Sapporo, Japan
| | - T Asagiri
- Department of Clinical Laboratory Medicine, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi, Japan
| | - T Eguchi
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi, Japan
| | - Y Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi, Japan
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Gast KC, Hoversten K, Patnaik MM. 45-Year-Old Man With Abdominal Pain and Splenomegaly. Mayo Clin Proc 2018; 93:e113-e117. [PMID: 30269944 DOI: 10.1016/j.mayocp.2018.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Kelly C Gast
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kate Hoversten
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Mrinal M Patnaik
- Advisor to residents and Consultant in Hematology, Mayo Clinic, Rochester, MN.
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Densky J, Patel T, Halderman A, Malhotra P. Extramedullary hematopoiesis of the sphenoid sinus associated with hereditary spherocytosis: A case report. Int J Pediatr Otorhinolaryngol 2018; 114:1-4. [PMID: 30262344 DOI: 10.1016/j.ijporl.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022]
Abstract
Extramedullary hematopoiesis is a rare cause of a sinonasal mass that presents unique diagnostic and treatment challenges. While there are numerous reports of patients with hereditary spherocytosis developing extramedullary hematopoiesis in the posterior mediastinum, involvement in the paranasal sinuses has not previously been described. Here, we present the first case of a patient with hereditary spherocytosis developing extramedullary hematopoiesis in the sphenoid sinus.
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Affiliation(s)
- Jaron Densky
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road Suite 4000, Columbus, OH, 43212, USA
| | - Tirth Patel
- College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Ashleigh Halderman
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Prashant Malhotra
- Department of Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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15
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Daum LM, Sklar LR, Mehregan DR. Blueberry muffin rash secondary to hereditary spherocytosis. Cutis 2018; 101:111-114. [PMID: 29554165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The term blueberry muffin rash is used to describe the clinical presentation of dermal extramedullary hematopoiesis. The common culprits of this rash include a TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus, herpes) infection or hematologic dyscrasia. Association of this rash with hereditary spherocytosis is extremely rare. We present a unique case of a neonate born with a blueberry muffin rash secondary to hereditary spherocytosis.
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Affiliation(s)
- Lisa M Daum
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
| | - Lindsay R Sklar
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
| | - Darius R Mehregan
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
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16
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Affiliation(s)
- Joseph Rencic
- From the Department of Medicine, Tufts Medical Center, Boston (J.R., M.Z.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.H., G.D.)
| | - Mengyu Zhou
- From the Department of Medicine, Tufts Medical Center, Boston (J.R., M.Z.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.H., G.D.)
| | - Gerald Hsu
- From the Department of Medicine, Tufts Medical Center, Boston (J.R., M.Z.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.H., G.D.)
| | - Gurpreet Dhaliwal
- From the Department of Medicine, Tufts Medical Center, Boston (J.R., M.Z.); and the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco Veterans Affairs Medical Center - both in San Francisco (G.H., G.D.)
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17
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Birlutiu V, Birlutiu RM. Sepsis due to Streptococcus pneumoniae associated with secondary hemophagocytic lymphohistiocytosis in a splenectomized patient for spherocytosis: A case report. Medicine (Baltimore) 2017; 96:e7520. [PMID: 28700505 PMCID: PMC5515777 DOI: 10.1097/md.0000000000007520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Hemophagocytic lymphohistiocytosis (HLH) is a syndrome that is characterized by an inappropriate hyperinflammatory immune response - primary, as a consequence of a genetic defect of NK cells and cytotoxic T lymphocytes or - secondary, in the progression of infections, rheumatic or autoimmune diseases, malignancies or metabolic diseases. PATIENT CONCERNS We present the case of a secondary HLH due to Streptococcus pneumoniae infection in a splenectomised patient for spherocytosis, a 37-year-old patient who was splenectomised in childhood for spherocytosis, without immuneprophylaxis induced by antipneumococcal vaccine. OUTCOMES He developed a severe pneumococcal sepsis associated with secondary HLH, with unfavorable outcome and death. LESSONS To our knowledge, just 2 similar cases had been published in the literature, none in which the secondary HLH was the consequence of an invasive pneumococcal infection in a splenectomized patient for spherocytosis, and the association of splenectomy with HLH is surprizin.
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Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu
- Academic Emergency Hospital Sibiu, Infectious Diseases Clinic, Sibiu
| | - Rares Mircea Birlutiu
- Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu
- Spitalul Clinic de Ortopedie-Traumatologie si TBC Osteoarticular “Foisor” Bucuresti, Romania
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18
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Aiso M, Yagi M, Tanaka A, Miura K, Miura R, Arizumi T, Takamori Y, Nakahara S, Maruo Y, Takikawa H. Gilbert Syndrome with Concomitant Hereditary Spherocytosis Presenting with Moderate Unconjugated Hyperbilirubinemia. Intern Med 2017; 56:661-664. [PMID: 28321066 PMCID: PMC5410476 DOI: 10.2169/internalmedicine.56.7362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We experienced a case of a 19-year-old man with Gilbert syndrome with concomitant hereditary spherocytosis. The patient presented with moderate unconjugated hyperbilirubinemia, and inherited etiology was strongly suspected. The diagnosis of Gilbert syndrome was confirmed by the genetic analysis of the UGT1A1 gene, demonstrating UGT1A1*28 and compound heterozygote UGT1A1*6. In addition, since the laboratory findings and imaging studies revealed lysemia as well as gallstone and splenomegaly, a diagnosis of hereditary spherocytosis was made as a comorbidity. Both Gilbert syndrome and hereditary spherocytosis are hereditary diseases with a high frequency, and the hyperbilirubinemia may be exacerbated when these two diseases are concomitant.
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Affiliation(s)
- Mitsuhiko Aiso
- Department of Medicine, Teikyo University School of Medicine, Japan
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19
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Ghafoor R, Anwar MI. Successful Treatment of Haemoglobinopathy Associated Chronic Leg Ulcer with Platelet Rich Plasma. J Coll Physicians Surg Pak 2016; 26:545-546. [PMID: 27354001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/18/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Rabia Ghafoor
- Department of Dermatology, Jinnah Postgraduate Medical Centre (JPMC), Karachi
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20
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21
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Ghimire P, Gurung NV, Shrestha S, Poudel SR, Chapagain A. Hereditary Spherocytosis with Splenomegaly and Cholelithiasis in a Young Male of Western Region of Nepal - A Case Report. Kathmandu Univ Med J (KUMJ) 2015; 13:366-368. [PMID: 27423290 DOI: 10.3126/kumj.v13i4.16839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hereditary spherocytosis is an autosomal dominant congenital hemolytic anemia due to defect in RBC membrane protein that commonly presents with intermittent jaundice, anemia, abdominal pain, splenomegaly and sometimes cholelithiasis. Due to the membrane defect, there is increased fragility, hemolytic anemia, marked splenomegaly and hyperbilirubinemia. This is a report of an 11 years old male diagnosed case of hereditary spherocytosis who presented with jaundice, splenomegaly and cholelithiasis. He underwent elective open splenectomy and cholecystectomy after prophylactic immunization for capsulated organisms and was advised lifelong oral penicillin prophylaxis post-splenectomy.
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Affiliation(s)
- P Ghimire
- Department of Surgery Western Regional Hospital Pokhara, Nepal
| | - N V Gurung
- Department of Surgery Western Regional Hospital Pokhara, Nepal
| | - S Shrestha
- Department of Surgery Western Regional Hospital Pokhara, Nepal
| | - S R Poudel
- Department of Surgery Western Regional Hospital Pokhara, Nepal
| | - A Chapagain
- Department of Surgery Western Regional Hospital Pokhara, Nepal
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22
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Donato H, Crisp RL, Rapetti MC, García E, Attie M. [Hereditary spherocytosis. Review. Part II. Symptomatology, outcome, complications, and treatment]. ARCH ARGENT PEDIATR 2015; 113:168-76. [PMID: 25727830 DOI: 10.5546/aap.2015.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/22/2014] [Indexed: 11/12/2022]
Abstract
Hereditary spherocytosis must always be suspected in children with anemia, hyperbilirubinemia, splenomegaly or cholelithiasis, in the asymptomatic individual with an affected relative, and in the neonate with hyperbilirubinemia with no blood group incompatibility; its early detection is key to avoid kernicterus. Follow-up of these patients is based on periodical control and supply of information on the adequate management of hemolytic or aplastic crisis, and early detection of cholelithiasis. The decision to perform splenectomy is usually associated with quality of life rather than life-threatening risk, and it should result from a consensus between patient, parents and physicians. The postsplenectomy follow-up is based on control of compliance with the prophylactic antibiotic therapy and the early diagnosis of infectious disorders.
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23
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Özyörük D, Demir HA, Emir S, Karakuş E, Tunç B. Occurrence of Wilms' tumor in a child with hereditary spherocytosis. Turk J Pediatr 2015; 57:206-209. [PMID: 26690609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hereditary spherocytosis (HS) is the most frequent cause of congenital hemolytic anemia. It is an autosomal dominant genetic disorder characterized by cell membrane abnormalities, specifically in red blood cells. Although the association between benign, borderline and malignant tumors and HS is not clear, various tumors such as splenoma, adrenal myolipoma, pancreatic schwannoma, ganglioneuroma, extramedullary hematopoiesis, myeloproliferative disorders, multiple myeloma, B-cell lymphoma and acute lymphoblastic leukemia have been presented in case reports concerning HS patients. Here we describe a 6-year-old boy with HS who presented with a mass in the left kidney. Tru-cut biopsy revealed Wilms' tumor (WT). To the best of our knowledge, this is the first case of WT associated with HS to be reported in the literature.
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Affiliation(s)
- Derya Özyörük
- Division of Pediatric Oncology, Department of Pediatrics, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey.
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24
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Ruparel RK, Bogert JN, Moir CR, Ishitani MB, Khan SP, Rodriguez V, Zarroug AE. Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary? J Pediatr Surg 2014; 49:433-5. [PMID: 24650472 DOI: 10.1016/j.jpedsurg.2013.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/12/2013] [Accepted: 05/14/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND/PURPOSE Expert guidelines recommend performing synchronous splenectomy in patients with mild hereditary spherocytosis (HS) and symptoms of gallstone disease. This recommendation has not been widely explored in the literature. The aim of this study is to determine if our data support expert opinion and if different practice patterns should exist. METHODS This is an IRB-approved retrospective study. All HS patients under 18 years of age who underwent cholecystectomy for symptomatic gallstones at a single institution between 1981 and 2009 were identified. Patients who underwent cholecystectomy without concurrent splenectomy were reviewed retrospectively for future need for splenectomy and evidence of recurrent gallstone disease. RESULTS Of the 32 patients identified, 27 underwent synchronous splenectomy. The remaining 5 patients underwent cholecystectomy without splenectomy and had a mean age of 9.4 years. One of the 5 patients eventually required splenectomy for left upper quadrant pain. None of the remaining 4 required hospitalization for symptoms related to hemolysis or hepatobiliary disease. Median follow-up is 15.6 years. CONCLUSION The need for splenectomy in patients with mild HS and symptomatic cholelithiasis should be assessed on a case by case basis. Our recommendation is to not perform synchronous splenectomy in conjunction with cholecystectomy for these patients if no indication for splenectomy exists.
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Affiliation(s)
- Raaj K Ruparel
- Division of GI and General Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - James N Bogert
- Division of GI and General Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Shakila P Khan
- Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abdalla E Zarroug
- Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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25
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Affiliation(s)
- Neal Varughese
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
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26
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Du-Thanh A, Aguilar-Martinez P, Enescu C, Cunat S, Guillot B, Dereure O. Porphyria cutanea tarda and spherocytosis: a non-random association? Acta Derm Venereol 2013; 93:377-8. [PMID: 23093332 DOI: 10.2340/00015555-1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Demir HA, Ozdel S, Kaçar A, Senel E, Emir S, Tunç B. Ganglioneuroma in a child with hereditary spherocytosis. Turk J Pediatr 2012; 54:187-190. [PMID: 22734309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hereditary spherocytosis (HS) is the most frequent cause of congenital hemolytic anemia. Extramedullary hematopoiesis (EMH) mimicking a mass may develop in the lymph nodes, kidneys, pleura, mediastinum, adrenal gland, and in particular the spleen and liver. Other than EMH, B-cell lymphoma, acute lymphoblastic leukemia, and pancreatic schwannoma cases were reported in patients with HS. We present a 13-year-old female patient with HS and ganglioneuroma in the adrenal gland. This association is probably coincidental; however, with increasing cancer cases in HS and the genetic studies being made, this association will be clarified.
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Affiliation(s)
- Haci Ahmet Demir
- Divisions of Pediatric Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
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28
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Zhao TK, Guo HX, Zhang LM. [Adrenal extramedullary hematopoiesis associated with hereditary spherocytosis: report of a case]. Zhonghua Xue Ye Xue Za Zhi 2012; 33:251. [PMID: 22781624] [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: 06/01/2023]
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29
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Cefalo MG, Arlotta A, Maurizi P, Russo I, Sani I, Battista A, Mastrangelo S, Ruggiero A, Riccardi R. Human parvovirus B 19 and Epstein-Barr virus co-infection in a child with hereditary spherocytosis. Eur Rev Med Pharmacol Sci 2012; 16:265-269. [PMID: 22428480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND In patients with chronic congenital haemolytic disorders, human Parvovirus B19 (HPV B19) is frequently involved in pure red-cell aplastic crises. Furthermore, it may inhibit three-lineage haematopoiesis in the bone marrow, causing severe pancytopenia. In such patients, Epstein Barr virus (EBV) infection also seems to share the same mechanism as HPV B19 in inducing bone marrow aplasia, but at present the clinical effect of an infection sustained by both viruses is unknown. CLINICAL REPORT We present a 7-year-old boy affected by hereditary spherocytosis (HS) who suffered from transient aplastic crisis, in whom laboratory findings revealed a double HPV B19 and EBV infection. CONCLUSIONS To our knowledge, this is the first report of a case of HPV B19 and EBV co-infection diagnosis in a paediatric patient. Despite underlying HS, no signs of haemolytic anaemia were detected, but the infection only produced transient pancytopenia. Nevertheless, the reason why there was no additive effect of the two viruses on the aplastic crisis is still unclear.
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Affiliation(s)
- M G Cefalo
- Division of Paediatric Oncology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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30
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Tso ACY, Roper DR, Wong CL, Bain B, Layton DM. Splenic infarction in a patient with sickle cell trait and hereditary spherocytosis. Am J Hematol 2011; 86:695-6. [PMID: 21509796 DOI: 10.1002/ajh.22015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 02/14/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Allison C Y Tso
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, United Kingdom.
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31
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Johnson A, Mills W. Jaundice and lethargy in a 26 year old man. BMJ 2011; 343:d3767. [PMID: 21746773 DOI: 10.1136/bmj.d3767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Salemme M, Rodella R, Fisogni S, Facchetti F. Nodular extramedullary hematopoiesis involving the adrenal gland. An uncommon cause of adrenal "incidentaloma". Pathologica 2011; 103:46-49. [PMID: 21797143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Adrenal extramedullary hematopoiesis may occur in association with various hematologic diseases. Its identification is invariably incidental, imaging of the lesion is poorly specific and the diagnosis requires the histological examination. We report a case of extramedullary hematopoiesis involving the right adrenal gland in a patient with hereditary spherocytosis. The literature on this entity has been reviewed and the differential with other conditions involving the adrenal gland and showing hematopoietic tissue infiltration is discussed.
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Affiliation(s)
- M Salemme
- Department of Pathology I, Spedali Civili, University of Brescia, Italy.
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33
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Abstract
Patients with co-existing hereditary spherocytosis (HS) and UDP-glucuronosyltransferase 1A1 (UGT1A1) deficiency as Gilbert's syndrome (GS) have been reported, and previous studies have demonstrated an increased risk for developing gallstones in patients with co-inheritance of GS and HS. We experienced an interesting case of HS showing persistent jaundice after splenectomy, and upon further evaluation, the 25-year-old female patient was found to have HS combined with UGT1A1 deficiency. Sequence analysis of the UGT1A1 gene revealed that she was a compound heterozygote with p.[G71R; Y486D] + [Y486D] mutations, which suggests Crigler-Najjar syndrome type II rather than GS. Careful evaluation of inappropriately elevated bilirubin level compared with the degree of hemolysis is important, reflecting the therapeutic implication of splenectomy and cholecystectomy.
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Affiliation(s)
- Shigeo Iijima
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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34
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Orser AJ, Hurst JM, Odom SR. Splenic trauma in a pediatric patient with hereditary spherocytosis. Am Surg 2011; 77:E22-E23. [PMID: 21352684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Autumn J Orser
- The Children's Hospital of Denver, Aurora, Colorado, USA
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35
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Agarwal SK, Binbrek AS, Thompson JA, Siddiqui SAP. Massive pulmonary embolism and acute limb ischaemia in a patient of hereditary spherocytosis and patent foramen ovale. Heart Lung Circ 2010; 19:742-4. [PMID: 20619736 DOI: 10.1016/j.hlc.2010.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/09/2010] [Accepted: 05/20/2010] [Indexed: 11/19/2022]
Abstract
Paradoxical embolism accounts for 2% of patients who present with acute arterial embolism of extremities. We report a case of a 41 year-old male with hereditary spherocytosis who presented to the emergency department with acute limb ischaemia and pulmonary embolism. On further evaluation, he was found to have patent foramen ovale (PFO) and deep vein thrombosis (DVT), leading to paradoxical embolism. The purpose of this report is to emphasise that in a patient presenting with acute limb ischaemia without an obvious systemic arterial embolic source, an evaluation for a right-to-left shunting lesion, especially PFO, should be performed.
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Affiliation(s)
- S K Agarwal
- Rashid Hospital, PO Box 4545, Dubai, United Arab Emirates.
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36
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Zhao CY, Wang W, Liu YH, Wang YD, Zhou JY. [Severe intrahepatic cholestasis and hemochromatosis secondary to hereditary spherocytosis]. Zhonghua Gan Zang Bing Za Zhi 2010; 18:552-553. [PMID: 20678455 DOI: 10.3760/cma.j.issn.1007-3418.2010.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Cai-Yan Zhao
- Department of Infectious Disease, Hebei Medical University the Third Affiliated Hospital, Shijiazhuang 050051, China.
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37
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Kara T, Akpinar E, Sarikaya B, Dagoglu G, Akhan D. Bile sludge that mimics hydatid cyst membranes: a potential pitfall for ultrasound. J Gastrointestin Liver Dis 2010; 19:126. [PMID: 20593042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Taylan Kara
- Department of Radiology, Beykehim Hospital, Selcuklu, Konya
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38
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Carzavec D, Gaćina P, Vasilj A, Katović SK. Aplastic crisis induced by human parvovirus B19 as an initial presentation of hereditary spherocytosis. Coll Antropol 2010; 34:619-621. [PMID: 20698139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The association between aplastic crisis and human parvovirus (HPV) B19 infection has been described in patients with hereditary spherocytosis (HS). Most cases of aplastic crisis in patients with HS induced by HPV B19 have been reported in children and adolescents. In this paper, we describe an aplastic crisis induced by HPV B19 in the 34 year old female as an initial presentation of HS. Although other viral illnesses cause some decompensation in HS, the anemia is rarely as profound as seen in acute HPV B19 infections.
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Affiliation(s)
- Dubravka Carzavec
- Department of Hematology, University Clinic of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb, Croatia.
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39
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Abstract
A 12-year-old girl was brought to the Dhaka Hospital of ICDDR,B with diarrhoea. Incidentally, the parents provided a history of repeated episodes of pallor and jaundice since she was two and half years old. Three of her family members had similar problems. History, clinical examination, and laboratory findings of the girl and her family members suggested a case of hereditary spherocytosis. To our knowledge, this is the first report of such a case in Bangladesh.
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Affiliation(s)
- Sayeeda Huq
- Clinical Sciences Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh
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40
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Biyikli NK, Gokce I, Cakalagaoglu F, Turkkan E, Alpay H. Hereditary spherocytosis with immunoglobulin A nephropathy. Iran J Kidney Dis 2010; 4:78-81. [PMID: 20081310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hereditary spherocytosis is a familial hemolytic anemia. Immunoglobulin A (IgA) nephropathy associated with hereditary spherocytosis has not been reported in children. Here, we report a case of a 17-year-old boy with IgA nephropathy and hereditary spherocytosis. The patient was diagnosed with hereditary spherocytosis at the age of 12 years and splenectomy was done at the age of 15 years. Later, the patient presented with macroscopic hematuria and proteinuria. Kidney biopsy of the boy was consistent with IgA nephropathy. Treatment with angiotensin-converting enzyme inhibitor was started. The patient became free of proteinuria after the 6th month of therapy.
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Affiliation(s)
- Nese Karaaslan Biyikli
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey.
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41
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Bouva MJ, Harteveld CL, Bakker-Verweij G, van Delft P, Giordano PC. Gγ −37 (A→T): A New Nondeletional Hereditary Persistence of Fetal Hemoglobin Determinant Associated with the Rare Codon 91 (+T) δ0-Thalassemia. Hemoglobin 2009; 30:371-7. [PMID: 16840228 DOI: 10.1080/03630260600755641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We recently described a rare frameshift mutation in the delta-globin gene in a Dutch patient, in association with a new mutation of the Ggamma-globin gene promoter [Ggamma -37 (A-->T)] with a moderately elevated Hb F level of 2.3%. The delta mutation at codon 91 (+T) has been described once before in our laboratory in 1989, in a complex Belgian family with Ggamma (Agammadeltabeta)0-thalassemia (thal) and moderately elevated Hb F levels, without the Ggamma (Agammadeltabeta)0-thal deletion in some individuals. Analysis of the patients from 1989 revealed the presence of the same Ggamma-globin gene mutation and moderately elevated Hb F in all patients, who were also carriers of the delta-globin gene frameshift. Further analysis demonstrated that the two mutations were in linkage with the same haplotype in both the Belgian family and the recently found patient, confirming the association of the elevated Hb F expression with the new Ggamma-globin gene mutation.
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Affiliation(s)
- Marelle J Bouva
- Department of Human and Clinical Genetics, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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42
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44
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Gupta P, Eshaghi N, Ghole V, Ketkar M, Garcia-Morales F. Presacral extramedullary hematopoiesis: report of a case and review of the literature. Clin Imaging 2008; 32:487-9. [PMID: 19006781 DOI: 10.1016/j.clinimag.2008.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 04/02/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Pramod Gupta
- Radiology Service, Dallas VA Medical Center, VA North Texas Health Care System, 4500, South Lancaster Road, Dallas, TX 75216, USA.
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45
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Garg PK, Kumar A, Teckchandani N, Hadke NS. Hereditary spherocytosis coexisting with Gilbert's syndrome: a diagnostic dilemma. Singapore Med J 2008; 49:e308-e309. [PMID: 19037536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Haemolytic anaemia generally gives rise to only a modest elevation of serum bilirubin. Unconjugated hyperbilirubinaemia of an extreme degree should raise suspicion of additional factors, such as Gilbert's syndrome, hepatocellular dysfunction or renal failure. We present a 17-year-old boy with hereditary spherocytosis coexisting with Gilbert's syndrome.
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Affiliation(s)
- P K Garg
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, India.
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46
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Abstract
BACKGROUND It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. OBJECTIVE To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. METHODS Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. RESULTS The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8-17.2; venous, HR 3.3, 95% CI 1.1-9.8]. CONCLUSION There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.
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Affiliation(s)
- R F Schilling
- Department of Medicine, Emeritus, University of Wisconsin-Madison, Madison, WI, USA.
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47
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Aksoy M, Erdem S, Dincol G, Erdogan G, Cilingiroglu K, Dincol K. Combination of hereditary elliptocytosis and hereditary spherocytosis. Clin Genet 2008; 6:46-50. [PMID: 4426130 DOI: 10.1111/j.1399-0004.1974.tb00629.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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48
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Smedema JP, Abrahams S, Louw VJ. Partial reversal of hemolysis-associated pulmonary arterial hypertension in response to oral administration of L-arginine in a patient with hereditary spherocytosis. Acta Haematol 2007; 118:167-8. [PMID: 17890851 DOI: 10.1159/000108767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 07/18/2007] [Indexed: 11/19/2022]
MESH Headings
- Administration, Oral
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anticoagulants/administration & dosage
- Arginine/administration & dosage
- Aspirin/administration & dosage
- Hemolysis
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/physiopathology
- Male
- Middle Aged
- Spherocytosis, Hereditary/blood
- Spherocytosis, Hereditary/complications
- Spherocytosis, Hereditary/drug therapy
- Spherocytosis, Hereditary/physiopathology
- Vasodilator Agents/administration & dosage
- Warfarin/administration & dosage
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49
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Abstract
BACKGROUND Recent data suggest that adults with hereditary spherocytosis (HS) may be protected from atherothrombosis before splenectomy but have increased risk of thrombosis following splenectomy. In order to aid in making informed decisions regarding splenectomy in children with HS, we conducted a retrospective study of several surrogate laboratory markers of thrombosis risk in children with HS. METHODS A retrospective record review was performed on 246 children with HS. Platelet count and hemoglobin concentration were recorded prior to and following splenectomy in each patient. Serum cholesterol levels were collected from the record when available. RESULTS Prior to splenectomy, hypocholesterolemia was common. Mean platelet counts in 31 evaluable patients pre- and post-splenectomy were 334 and 608 x 10(9)/L, respectively (P < 0.001). Twenty-nine patients (94%) exhibited persistent thrombocytosis following splenectomy. Hemoglobin values following splenectomy often rose to higher than age and gender-matched norms, with 30% of measurements greater than the 90th percentile and 17% greater than the 97th percentile. CONCLUSIONS The findings of hypocholesterolemia before splenectomy and thrombocytosis and mild polycythemia afterwards support the hypothesis that patients with HS might be protected from thrombosis before splenectomy and/or more susceptible afterwards. Prospective studies of additional prothrombotic biomarkers and thrombotic events in HS patients are warranted.
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Affiliation(s)
- Sarah B Troendle
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA
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50
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Prabhakaran K, Jacobs BL, Smaldone MC, Franks ME. Stuttering priapism associated with hereditary spherocytosis. Can J Urol 2007; 14:3702-3704. [PMID: 17949526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Stuttering priapism is a clinical phenomenon that occurs commonly in certain patient populations, including sickle cell anemia and other hematologic dyscrasias. Although the mechanism is still not completely understood, treatment is focused on prevention of recurrence in the outpatient setting, and immediate detumescence and minimizing corporal fibrosis in the acute setting. We present a case of stuttering priapism in a 44 year-old male with hereditary spherocytosis and discuss the pathophysiology and clinical management of this entity.
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Affiliation(s)
- Karti Prabhakaran
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-3232, USA
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