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Cai G, Jayaraman D. Spontaneous, simultaneous bilateral osteonecrosis of the femoral heads in a patient with sideroblastic anaemia with B-cell immunodeficiency, periodic fever and developmental delay syndrome. BMJ Case Rep 2023; 16:e254175. [PMID: 37130647 PMCID: PMC10163426 DOI: 10.1136/bcr-2022-254175] [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: 05/04/2023] Open
Abstract
Sideroblastic anaemia with B-cell immunodeficiency, periodic fever and developmental delay is a recently described, rare syndrome characterised by numerous manifestations underpinned by mutations in transfer RNA nucleotidyltransferase. The pathogenesis arises from mitochondrial dysfunction, with impaired intracellular stress response, deficient metabolism and cellular and systemic inflammation. This yields multiorgan dysfunction and early death in many patients with survivors suffering significant disability and morbidity. New cases, often youths, are still being described, expanding the horizon of recognisable phenotypes. We present a mature patient with spontaneous bilateral hip osteonecrosis that likely arises from the impaired RNA quality control and inflammation caused by this syndrome.
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Maccora I, Ramanan AV, Wiseman D, Marrani E, Mastrolia MV, Simonini G. Clinical and Therapeutic Aspects of Sideroblastic Anaemia with B-Cell Immunodeficiency, Periodic Fever and Developmental Delay (SIFD) Syndrome: a Systematic Review. J Clin Immunol 2023; 43:1-30. [PMID: 35984545 PMCID: PMC9840570 DOI: 10.1007/s10875-022-01343-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Sideroblastic anaemia with B-cell immunodeficiency, periodic fever and developmental delay (SIFD) syndrome is a novel rare autoinflammatory multisystem disorder. We performed a systematic review of the available clinical and therapeutics aspects of the SIFD syndrome. METHODS A systematic review according to PRISMA approach, including all articles published before the 30th of July 2021 in Pubmed and EMBASE database, was performed. RESULTS The search identified 29 publications describing 58 unique patients. To date, 41 unique mutations have been reported. Onset of disease is very early with a median age of 4 months (range 0-252 months). The most frequent manifestations are haematologic such as microcytic anaemia or sideroblastic anaemia (55/58), recurrent fever (52/58), neurologic abnormalities (48/58), immunologic abnormalities in particular a humoral immunodeficiency (48/58), gastrointestinal signs and symptoms (38/58), eye diseases as cataract and retinitis pigmentosa (27/58), failure to thrive (26/58), mucocutaneous involvement (29/58), sensorineural deafness (19/58) and others. To date, 19 patients (35.85%) died because of disease course (16) and complications of hematopoietic cell stems transplantation (3). The use of anti-TNFα and hematopoietic cell stems transplantation (HCST) is dramatically changing the natural history of this disease. CONCLUSIONS SIFD syndrome is a novel entity to consider in a child presenting with recurrent fever, anaemia, B-cell immunodeficiency and neurodevelopmental delay. To date, therapeutic guidelines are lacking but anti-TNFα treatment and/or HCST are attractive and might modify the clinical course of this syndrome.
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Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
- NeuroFARBA Department, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children and Translational Health Sciences, University of Bristol, Bristol, UK
| | - Daniel Wiseman
- Department of Haematology, Royal Manchester Children's Hospital, Manchester, UK
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Maria V Mastrolia
- Rheumatology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
- NeuroFARBA Department, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy
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Kisla Ekinci RM, Zararsiz A, Demir GU, Anlas O. A Rare Autoinflammatory Disorder in a Pediatric Patient with Favorable Response to Etanercept: Sideroblastic Anemia with B Cell Immunodeficiency, Periodic Fevers, and Developmental Delay Syndrome. Pediatr Allergy Immunol Pulmonol 2022; 35:129-132. [PMID: 36121781 DOI: 10.1089/ped.2022.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Sideroblastic anemia with B cell immunodeficiency, periodic fevers, and developmental delay (SIFD) syndrome is caused by biallelic TRNT1 mutations. TRNT1 gene encodes a CCA-adding tRNA nucleotidyl transferase enzyme. Mutant TRNT1 results in immunodeficiency and anemia in various degrees, accompanied by several organ involvement. Case Presentation: We present here a 15-month old male, demonstrated brittle hair, growth hormone deficiency, recurrent fever, arthritis, recurrent infections, mild anemia, and hypogammaglobulinemia. The patient did not respond to colchicine treatment, and after establishing SIFD diagnosis with the presence of homozygote c.948-949delAAinsGG (p.Lys317Glu) mutation in TRNT1 gene, we commenced monthly intravenous immunoglobulin replacement and weekly subcutaneous etanercept. A rapid resolution of fever episodes and infections occurred after initiation of this treatment regimen. Afterward, both anemia and growth parameters have improved during follow-up. Conclusion: SIFD syndrome should be considered in patients with recurrent fever, arthritis, and growth retardation even in the absence of severe anemia and prominent hypogammaglobulinemia.
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Affiliation(s)
| | | | - Gizem Urel Demir
- Department of Pediatric Genetics, Mersin City Hospital, Mersin, Turkey
| | - Ozlem Anlas
- Department of Department of Medical Genetics, Adana City Training and Research Hospital, Adana, Turkey
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Vobugari N, Chaturvedi M, Schlam-Camhi IM, Smith HP. Sideroblastic anaemia in a patient with sickle cell disease. BMJ Case Rep 2022; 15:15/2/e246623. [PMID: 35135795 PMCID: PMC8830102 DOI: 10.1136/bcr-2021-246623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sideroblastic anaemia is a rare condition. We report a unique case of concomitant sideroblastic anaemia in a patient with sickle cell disease with long-standing blood transfusion history. Due to a low prevalence of sideroblastic anaemia, the diagnosis of sideroblastic anaemia is often difficult, especially when coexisting with common types of anaemia, including sickle cell disease. This case highlights the detrimental effects of anchoring bias. Rare causes of refractory anaemia should be considered in patients with haemoglobin disorders as the therapeutic approaches for these conditions are different. High suspicion on the part of the clinician and low threshold for workup of anaemia often aids in the diagnosis of coexisting conditions such as sideroblastic anaemia. Early diagnosis and treatment of sideroblastic anaemia improves patient outcomes and prevents long-term complications.
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Affiliation(s)
- Nikitha Vobugari
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mansi Chaturvedi
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ilana Miriam Schlam-Camhi
- Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
- Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hedy Patricia Smith
- Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC, USA
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5
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Vigneshwaran J, Kumar MS, Raghavan V, Sundari S. Seizures and sideroblastic anaemia in a patient with multidrug-resistant tuberculosis. Lancet 2022; 399:393. [PMID: 35065787 DOI: 10.1016/s0140-6736(22)00013-7] [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: 10/28/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
- J Vigneshwaran
- Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India
| | - M Senthil Kumar
- Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India.
| | - Vijayashree Raghavan
- Department of Pathology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India
| | - Sivagama Sundari
- Department of Pathology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India
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Allain JS, Belhomme N, Henriot B, Haas M, Le Gall-Godard M, Pastoret C, Jego P. [A microcytic sideroblastic anemia successfully treated with B6 vitamin]. Rev Med Interne 2019; 40:462-465. [PMID: 31133329 DOI: 10.1016/j.revmed.2019.05.009] [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] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sideroblastic anemia is a rare cause of microcytic anemia, which is characterized by ring sideroblasts on bone marrow aspirate. This anemia can be congenital or acquired. CASE REPORT We report the case of an alcoholic 49-year-old man who presented with a severe microcytic sideroblastic anemia related to pyridoxine (B6 vitamin) deficiency. Acid folic deficiency was associated. The blood count normalized within one month after vitamin supplementation. CONCLUSION Pyridoxine deficiency must be sought in sideroblastic anemia in patients at risk.
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Affiliation(s)
- J-S Allain
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France; Pôle médecine, cardiovasculaire et métabolisme, centre hospitalier de Saint-Malo, 35400 Saint-Malo, France.
| | - N Belhomme
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - B Henriot
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France; Service de médecine interne et immunologie clinique, centre hospitalier René-Pleven, CHU de Rennes, 22100 Dinan, France
| | - M Haas
- Laboratoire d'hématologie, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - M Le Gall-Godard
- Laboratoire d'hématologie, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - C Pastoret
- Laboratoire d'hématologie, Inserm, UMR U1236, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
| | - P Jego
- Service de médecine interne et immunologie clinique, université de Rennes 1, CHU de Rennes, 35000 Rennes, France
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Kefala-Agoropoulou K, Roilides E, Lazaridou A, Karatza E, Farmaki E, Tsantali H, Augoustides-Savvopoulou P, Tsiouris J. Pearson syndrome in an infant heterozygous for C282Y allele of HFE gene. Hematology 2013; 12:549-53. [PMID: 17852457 DOI: 10.1080/10245330701400900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022] Open
Abstract
BACKGROUND Pearson syndrome is a rare mitochondrial disorder characterized by sideroblastic anemia, liver disease, renal tubulopathy and exocrine pancreas deficiency. OBSERVATIONS We describe a female infant suffering from anemia since birth who gradually developed the complete picture of Pearson syndrome by 13 months. Iron overload was disproportionate to blood transfusions. The patient was heterozygous for HFE gene C282Y mutation (type I hemochromatosis). After an initial response to deferoxamine she presented with cutaneous zygomycosis and died after metabolic derangement and Pneumocystis jiroveci pneumonia. CONCLUSION This is the second case of a Pearson syndrome individual who was also heterozygous for HFE gene mutation C282Y published. It is also the second case report of a Pearson patient suffering from severe iron overload and liver disease that responded to therapy with deferoxamine.
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Tatic A, Vasilică M, Coliţă A, Vasilache D, Dobrea C, Jardan C, Găman AM, Crişan AM, Coliţă D, Coriu D. Refractory anemia with ringed sideroblasts and thrombocytosis without JAK2 V617F mutation: report of three cases. Rom J Morphol Embryol 2013; 54:1177-1182. [PMID: 24399021] [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: 06/03/2023]
Abstract
In the WHO classification, there is a provisional entity called Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable (MDS/MPN, U). Refractory anemia with ringed sideroblasts associated with marked thrombocytosis (RARS-T) was included in this category. Recently published studies report a small percentage of patients with RARS-T. Sixty percent of these have JAK2 V617F mutation, which can suggest the coexistence of two pathological conditions (MDS and MPN). In this paper, we analyzed three patients diagnosed with RARS-T in the Department of Hematology, "Fundeni" Clinical Institute, Bucharest, Romania, during the period 2005-2011. The patients were investigated with cytogenetic exam and molecular biology. In these three cases were identified morphological features of multilineage dysplasia (two-lineage dysplasia in two cases and three-lineage dysplasia in one case). In two cases, thrombocytosis was under 1000×10(3)/μL and clinical evolution was similar to the myelodysplastic syndrome (transfusion dependent anemia with response to administration of erythropoietin). In the third case, the platelets were over 1000×10(3)/μL and with response to the treatment with Hydrea, which improved anemia. JAK2 V617F mutation was not identified in any case. RARS-T remains a provisional entity and requires a complex investigation of patients for the correct diagnosis of these patients. Therapeutic options should be personalized to each case in part because there is not yet a standardized treatment of these patients.
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Affiliation(s)
- Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, "Fundeni" Clinical Institute, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
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9
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Williams TB, Daniels M, Puthenveetil G, Chang R, Wang RY, Abdenur JE. Pearson syndrome: unique endocrine manifestations including neonatal diabetes and adrenal insufficiency. Mol Genet Metab 2012; 106:104-7. [PMID: 22424738 DOI: 10.1016/j.ymgme.2012.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/20/2012] [Accepted: 01/20/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Pearson syndrome is a very rare metabolic disorder that is usually present in infancy with transfusion dependent macrocytic anemia and multiorgan involvement including exocrine pancreas, liver and renal tubular defects. The disease is secondary to a mitochondrial DNA deletion that is variable in size and location. Endocrine abnormalities can develop, but are usually not part of the initial presentation. We report two patients who presented with unusual endocrine manifestations, neonatal diabetes and adrenal insufficiency, who were both later diagnosed with Pearson syndrome. METHODS Medical records were reviewed. Confirmatory testing included: mitochondrial DNA deletion testing and sequencing of the breakpoints, muscle biopsy, and bone marrow studies. RESULTS Case 1 presented with hyperglycemia requiring insulin at birth. She had several episodes of ketoacidosis triggered by stress and labile blood glucose control. Workup for genetic causes of neonatal diabetes was negative. She had transfusion dependent anemia and died at 24 months due to multisystem organ failure. Case 2 presented with adrenal insufficiency and anemia during inturcurrent illness, requiring steroid replacement since 37 months of age. He is currently 4 years old and has mild anemia. Mitochondrial DNA studies confirmed a 4.9 kb deletion in patient 1 and a 5.1 kb deletion in patient 2. CONCLUSION The patients reported highlight the importance of considering mitochondrial DNA disorders in patients with early onset endocrine dysfunction, and expand the knowledge about this rare mitochondrial disease.
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Affiliation(s)
- T B Williams
- Division of Metabolic Disorders, CHOC Children's, Orange, CA 92868, USA
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10
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Meo A, Ruggeri A, La Rosa MA, Zanghì L, Morabito N, Duca L. Iron Burden and Liver Fibrosis Decrease During a Long-Term Phlebotomy Program and Iron Chelating Treatment After Bone Marrow Transplantation. Hemoglobin 2009; 30:131-7. [PMID: 16540426 DOI: 10.1080/03630260500455615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
In this retrospective study, we report the results of the association of a combined phlebotomy program and chelation in hereditary sideroblastic anemia (HSA) to reduce iron overload after bone marrow transplantation (BMT). A male HSA patient, not responding to pyridoxine treatment, was submitted to successful allogeneic BMT. As there was a persistence of a tissue iron overload, a regular phlebotomy program was started followed by chelation. A significant decrease of iron burden was obtained using a combined treatment with deferoxamine (DFO) and deferiprone (L1) in addition to the phlebotomy program. A 10-year follow-up shows a marked decrease in the concentration of serum ferritin, non-transferrin-bound iron (NTBI), liver iron and normal hemoglobin (Hb), which allows the patient to reach and maintain a good quality of life.
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Affiliation(s)
- Anna Meo
- Paediatric Department, "G. Martino" Policlinico University of Messina, Messina, Italy.
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11
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Mori M, Nakamoto S, Akifuji Y, Tanaka T, Komatsu N, Hatake K, Ozawa K. Familial sideroblastic anemia associated with cardiac atrial septal defect. Am J Hematol 2009; 84:451-2. [PMID: 19425066 DOI: 10.1002/ajh.21425] [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: 01/19/2023]
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12
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Caen J, Popesco E, Jeanneau C, Sultan Y. Acquired haemorrhagic diathesis in sideroblastic anemia (megakaryocytopathy and thrombocytopathy). Acta Med Scand Suppl 2009; 525:283-6. [PMID: 5292103 DOI: 10.1111/j.0954-6820.1972.tb05845.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] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Ianotto JC, Tempescul A, Eveillard JR, Marion V, Quintin-Roué I, Berthou C. Tri-lineage disease involving sideroblastic anaemia, multiple myeloma and B-cell non-Hodgkin's lymphoma in the same patient. Ann Hematol 2008; 88:273-4. [PMID: 18719917 DOI: 10.1007/s00277-008-0586-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 07/29/2008] [Indexed: 11/28/2022]
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14
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Marque M, Bessis D, Guillot B, Dereure O. Neutrophilic dermatosis and sideroblastic anaemia: an unusual association. J Eur Acad Dermatol Venereol 2008; 23:219-20. [PMID: 18624852 DOI: 10.1111/j.1468-3083.2008.02809.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: 11/28/2022]
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15
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Nearman ZP, Szpurka H, Serio B, Warshawksy I, Theil K, Lichtin A, Sekeres MA, Maciejewski JP. Hemochromatosis-associated gene mutations in patients with myelodysplastic syndromes with refractory anemia with ringed sideroblasts. Am J Hematol 2007; 82:1076-9. [PMID: 17654685 DOI: 10.1002/ajh.20995] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [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: 12/23/2022]
Abstract
We observed increased ferritin levels in newly diagnosed MDS-RARS patients without transfusional iron-overload. Hence, we hypothesized RARS patients may harbor hemochromatosis-related mutations, which could contribute to the pathophysiology of this myelodysplastic syndromes (MDS) subset. We studied a cohort of 140 MDS patients: 42 with RARS, 10 with increased ringed sideroblasts, and 96 with other forms of MDS (43 RA, 27 RAEB, 17 RAEB-T, 8 MDS/MPD, 1 CMML). Patients were genotyped using restriction fragment length polymorphism, designed to detect C282Y and H63D mutations of the HFE gene. We found significantly higher frequency of heterozygosity for C282Y mutation in RARS patients compared with a large control population of matched race individuals (21 vs. 9.8% in controls, P = 0.03); H63D genotype was not significantly increased. Frequency of HFE variation in other MDS subtypes failed to differ significantly from controls. Within this group, we included patients with a rare form of MDS, provisionally subclassified by WHO as RARS with thrombocytosis (RARSt). 10/14 RARSt patients were carriers of either C282Y or H63D allele significantly increased compared with the combined prevalence in a healthy population (71 vs. 33%, P < 0.01). We found expected distribution of mutant HFE alleles in patients with other forms of MDS (9.1 vs. 9.8%, P = 0.82). Increased prevalence of HFE gene mutations is not a generalized feature of MDS, but some subgroups of MDS, especially those characterized by excessive accumulation of ringed sideroblasts, exhibit C282Y mutations at a higher frequency than in other forms of MDS and healthy controls.
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Affiliation(s)
- Zachary P Nearman
- Experimental Hematology and Hematopoiesis Section, Taussig Cancer Center, Cleveland, Ohio, USA
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Abstract
BACKGROUND A 56-year-old male with a history of excess alcohol consumption for over 10 years and type 2 diabetes mellitus (diagnosed 14 years previously) presented to the accident and emergency department with severe anemia and a 1-day history of nausea and 'coffee ground' vomiting. He had been admitted to hospital on several occasions in the previous 18 months, primarily because of anemia, and had received 30 units of transfused blood during this period. Previous extensive investigations included six esophagogastroduodenoscopies and a colonoscopy, a barium follow-through study, and a radionucleotide Meckel's scan. The prior working diagnosis was anemia secondary to blood loss. INVESTIGATIONS Laboratory investigations (full blood count [including reticulocytes], microscopic blood film examination, hematinics, liver function tests with direct and indirect bilirubin measurement, prothrombin time, and lactate dehydrogenase level), transjugular liver biopsy and bone-marrow biopsy. DIAGNOSIS Alcohol-related anemia caused by acute hemolysis, sideroblastic anemia and cirrhosis. MANAGEMENT Correction of anemia by blood transfusion (6 units), and prevention of recurrence by strict abstinence from alcohol.
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Affiliation(s)
- Gemma Lewis
- Department of Integrated Medicine, University of Wales, Cardiff, UK
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17
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Bykhovskaya Y, Mengesha E, Fischel-Ghodsian N. Pleiotropic effects and compensation mechanisms determine tissue specificity in mitochondrial myopathy and sideroblastic anemia (MLASA). Mol Genet Metab 2007; 91:148-56. [PMID: 17374500 PMCID: PMC1986728 DOI: 10.1016/j.ymgme.2007.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/06/2007] [Indexed: 11/30/2022]
Abstract
The tissue specificity of mitochondrial diseases is poorly understood. Recently, tissue-specific quantitative differences of the components of the mitochondrial translation system have been found to correlate with disease presentation in fatal hepatopathy caused by mutations in mitochondrial translation factor EFG1. MLASA is an autosomal recessive inherited progressive oxidative phosphorylation disorder that affects muscle and erythroid cells. The disease is caused by the homozygous point mutation C656T (R116W) in the catalytic domain of the pseudouridylate synthase 1 (PUS1) gene, which leads to a complete lack of pseudouridylation at the expected sites in mitochondrial and cytoplasmic tRNAs. Despite the presence of these altered tRNAs, most tissues are unaffected, and even in muscle and erythroid cells the disease phenotype only slowly emerges over the course of years. In order to elucidate intracellular pathways through which the homozygous mutation leads to tissue-restricted phenotype, we performed microarray expression analysis of EBV-transformed lymphoblasts from MLASA patients, heterozygous parents, and controls using human Beadchip microarray with 47,296 transcripts. Genes coding for proteins involved in DNA transcription and its regulation, and metal binding proteins, demonstrated major differences in expression between patients and all other individuals with normal phenotype. Genes coding for ribosomal proteins differed significantly between individual with at least one copy of the mutated PUS1 gene and controls. These findings indicate that the lack of tRNA pseudouridylation can be overcome by compensatory changes in levels of ribosomal proteins, and that the disease phenotype in affected tissues is likely due to pleiotropic effects of PUS1p on non-tRNA molecules involved in DNA transcription and iron metabolism. Similar combinations of mechanisms may play a role in the tissue specificity of other mitochondrial disorders.
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Affiliation(s)
- Yelena Bykhovskaya
- Medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Emebet Mengesha
- Medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathan Fischel-Ghodsian
- Medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Keijzer A, van der Valk P, Ossenkoppele GJ, van de Loosdrecht AA. Mucormycosis in a patient with low risk myelodysplasia treated with anti-TNF-alpha. Haematologica 2006; 91:ECR51. [PMID: 17194657] [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: 05/13/2023] Open
Abstract
Accelerated programmed cell death or apoptosis appears to play an important role in the pathogenesis of myelodysplasia. As overexpression of TNF-alpha has been described to induce cell death in myelodysplasia, treatment with anti-TNF-alpha is currently being explored. Caution is needed because of an increased risk of opportunistic infection during anti-TNF-alpha treatment. We here describe a patient who was treated with anti-TNF-alpha for low risk myelodysplasia and died of invasive mucormycosis.
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Affiliation(s)
- A Keijzer
- VU-University Medical centre Amsterdam, department of haematology, de Boelelaan 1117, BR 240,1081 HV, Amsterdam, The Netherlands.
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Barton JC, Lee PL. Disparate phenotypic expression of ALAS2 R452H (nt 1407 G → A) in two brothers, one with severe sideroblastic anemia and iron overload, hepatic cirrhosis, and hepatocellular carcinoma. Blood Cells Mol Dis 2006; 36:342-6. [PMID: 16540354 DOI: 10.1016/j.bcmd.2006.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 01/23/2006] [Accepted: 01/23/2006] [Indexed: 01/21/2023]
Abstract
We report the case of a man with severe X-linked sideroblastic anemia, severe iron overload, and hepatic cirrhosis who died of hepatocellular carcinoma. Evaluation of family members using DNA sequencing revealed that he was hemizygous for the novel ALAS2 mutation R452H (exon 9; nt 1407 G --> A). The proband's brother, an ALAS2 R452H hemizygote, had mild anemia and mild iron overload. Four female relatives were ALAS2 R452H heterozygotes, but they had mild or no anemia and no iron overload. Sequencing of TFR2, HFE, FPN1 (SLC40A1), HAMP, HJV, and the erythrocyte pyruvate kinase genes of family members was also performed. We thus detected the novel TFR2 missense mutation I449V (exon 10; nt 1345 A --> G) in the proband's wife and daughter, neither of whom had anemia or iron overload. Possible explanations for the disparate red blood cell and iron phenotypes of the proband and his family members are discussed.
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Affiliation(s)
- James C Barton
- Southern Iron Disorders Center, Birmingham, AL 35209, USA.
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D'Angelo G. Refractory anemia with ringed sideroblasts and chronic myelomonocytic leukemia: myelodysplastic/myeloproliferative disease. ACTA ACUST UNITED AC 2005; 11:171-3. [PMID: 16174602 DOI: 10.1532/lh96.05018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/20/2022]
Abstract
Here is reported the case of an elderly woman that, after surgical intervention, showed an important anemia, leucocytosis and thrombocytopenia. The leucocytosis was accompanied with clean increase of the monocytes. The morphological appearances, both peripheral blood and bone marrow, showed an evident overlapping of myelodysplastic and myeloproliferative picture, characterized from the presence of refractory anemia with ringed sideroblasts (RARS) and chronic myelomonocytic leukemia (CMML). The case has been reported because it is not frequent, besides, the CMML, until from the beginning of French-American-British (FAB) classification application, has raised problems of classification. Currently, the World Health Organization (WHO) has given an arrangement to the hematological picture with myelodysplastic and myeloproliferative morphological appearances, including this pathology in a new category: myelodysplastic/myeloproliferative diseases (MDS/MPD).
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Affiliation(s)
- Guido D'Angelo
- Azienda Ospedaliera S. Antonio Abate - Gallarate, Laboratorio di Chimica-Clinica, Ematologia e Microbiologia, Varese, Italy.
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Gérard J, Dubois-Galopin F, Gardembas-Pain M, Defaux JB, Schmidt-Tanguy A, Godon A, Geneviève F, Blanchet O, Ifrah N, Zandecki M. [Refractory anaemia with ringed sideroblasts (RARS) associated with marked thrombocytosis: a provisional entity in the WHO classification of haematological malignancies]. Ann Biol Clin (Paris) 2005; 63:653-9. [PMID: 16330386] [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] [Received: 08/10/2005] [Accepted: 09/09/2005] [Indexed: 05/05/2023]
Abstract
The WHO classification describes a group of myelodysplastic/myeloproliferative diseases, including a provisional entity, refractory anaemia with ringed sideroblasts (RARS) associated with marked thrombocytosis, underlining that is a provisional entity without consensus of belonging to myelodysplastic rather than to myeloproliferative syndromes. The authors report two cases with features of refractory anaemia with excess of ringed sideroblasts and marked thrombocytosis. In the first case, RARS is concomitant with thrombocytosis and fits the WHO criteria for this temporary entity. The second case is a typical RARS, who developed a thrombocytosis after several years and emphasizes that a link, at least progressive, exists between RARS and myeloproliferative disorders. The authors summed up the various situations related to secondary or primary acquired sideroblastic anaemia, likewise to primitive and reactive thrombocytosis. The cases of RARS + marked thrombocytosis reported in the literature are few in number and do not allow to settle between a particular form of myelodysplastic syndrome and a myeloproliferative disorder, a fully justified reason to classify these patients in a temporary group. To date, there is no codified therapy for this disorders.
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Affiliation(s)
- J Gérard
- Laboratoire d'hématologie biologique, Upres EA-3863, Angers.
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22
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Ye CC, Shah N, Edwards VD, Kirby-Allen M. A 16-year-old girl with hypochromic microcytic anemia. Arch Pathol Lab Med 2005; 129:e199-201. [PMID: 16253038 DOI: 10.5858/2005-129-e199-aygwhm] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Charles C Ye
- Division of Haematopathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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23
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Abstract
A missense mutation in the PUS1 gene affecting a highly conserved amino acid has been associated with mitochondrial myopathy and sideroblastic anemia (MLASA), a rare autosomal recessive oxidative phosphorylation disorder. The PUS1 gene encodes the enzyme pseudouridine synthase 1 (Pus1p) that is known to pseudouridylate tRNAs in other species. Total RNA was isolated from lymphoblastoid cell lines established from patients, parents, unaffected siblings, and unrelated controls, and the tRNAs were assayed for the presence of pseudouridine (Psi) at the expected positions. Mitochondrial and cytoplasmic tRNAs from MLASA patients are lacking modification at sites normally modified by Pus1p, whereas tRNAs from controls, unaffected siblings, or parents all have Psi at these positions. In addition, there was no Pus1p activity in an extract made from a cell line derived from a patient with MLASA. Immunohistochemical staining of Pus1p in cell lines showed nuclear, cytoplasmic, and mitochondrial distribution of the protein, and there is no difference in staining between patients and unaffected family members. MLASA is thus associated with absent or greatly reduced tRNA pseudouridylation at specific sites, implicating this pathway in its molecular pathogenesis.
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MESH Headings
- Anemia, Sideroblastic/complications
- Anemia, Sideroblastic/enzymology
- Anemia, Sideroblastic/genetics
- Base Sequence
- Cell Line
- Genes, Recessive
- Humans
- Hydro-Lyases/genetics
- Mitochondrial Myopathies/complications
- Mitochondrial Myopathies/enzymology
- Mitochondrial Myopathies/genetics
- Molecular Sequence Data
- Mutation, Missense
- Nucleic Acid Conformation
- Pseudouridine/chemistry
- RNA, Transfer/chemistry
- RNA, Transfer/genetics
- RNA, Transfer, Lys/chemistry
- RNA, Transfer, Lys/genetics
- RNA, Transfer, Ser/chemistry
- RNA, Transfer, Ser/genetics
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Affiliation(s)
- Jeffrey R Patton
- Department of Pathology and Microbiology, University of South Carolina School of Medicine, Columbia, USA
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González FA, Arrizabalaga B, Villegas A, Alonso D, Castro M, Remacha A, del Arco A, Martín Núñez G. Estudio del tratamiento con desferroxamina en perfusión subcutánea para la sobrecarga de hierro en pacientes con síndrome mielodisplásico. Med Clin (Barc) 2005; 124:645-7. [PMID: 15882510 DOI: 10.1157/13074739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The progressive accumulation of iron in the organism contribute to one of the most important problems of morbidity and mortality in patients with myelodysplastic syndrome (MDS). We present an observational protocol, multicentre, open and non-aleatheorised, in patients diagnosed with MDS on transfusional regime with iron overload. The study was meant to prove the effectiveness of the parenteral treatment with desferrioxamine using continuous devices of subcutaneous profusion and evaluate the evolution of iron overload as well as transfusional requirements. PATIENTS AND METHOD There were 28 patients (12 men and 16 women), 12 AR, 15 AS and 1 unknown. Average monitoring lasted 13.5 months and there was a gradual loss of patients. 11 of them had gone during the first year. RESULTS After 12 months the average of ferritin decreased by 258.51 ng/dl (DE 1208.04; p = 9.4) and after 24 months, it decreased by 979.6 ng/dl (DE 810.31; p = 0.1). After 12 months the average of requirements increased by 60.57 gHb/month (DE 183.7; p = 0.029) and after 24 months, it increased by 167.3 g/Hb/month (DE 406.5; p = 0.36). CONCLUSIONS Desferroxiamine treatment is effective at least to prevent an iron overload in these patients, and therefore should be incorporated in the clinical practice.
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Ljung T, Bäck R, Hellström-Lindberg E. Hypochromic red blood cells in low-risk myelodysplastic syndromes: effects of treatment with hemopoietic growth factors. Haematologica 2004; 89:1446-53. [PMID: 15590394] [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: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anemia of low-risk myelodysplastic syndromes (MDS), refractory anemia (RA) and RA with ringed sideroblasts (RARS), may respond to treatment with hematopoietic growth factors (GF)); erythropoietin (Epo) +/- granulocyte colony-stimulating factor (G-CSF). The present study was designed to assess whether functional iron deficiency may develop in MDS patients receiving these treatments. DESIGN AND METHODS Erythrocyte scattergrams from 34 patients with RA and RARS (untreated, transfused, or GF-treated with partial or complete erythroid response) were analyzed with Bayer-Advia equipment. RESULTS In untreated RARS, the proportion of hypochromic erythrocytes (Hypo-e, median 6.2%, range 1.1-8%) and hypochromic reticulocytes (Hypo-r, median 45%, range 22-48%), as well as mean corpuscular volume (MCV, median 101 fL) were significantly elevated compared to corresponding values in controls. These values increased further after GF-treatment (median 11%, 57%, and 105 fL, respectively), in spite of improved hemoglobin values and adequate body iron stores. The values observed in untreated RA patients largely fell within the normal range, and there was no significant influence of GF treatment. Notably, the hemoglobin content of reticulocytes (MCHr) did not differ between MDS and controls, and was not influenced by GF treatment. INTERPRETATION AND CONCLUSIONS The red cell population in RARS shows morphological abnormalities in terms of varying but overall increased size, and reduced hemoglobin concentration. The proportion of abnormal cells increases after successful pro-erythroid GF treatment, indicating that GF promote erythroblast survival, and maturation into erythrocytes. Hence, the finding of hypochromic red cells should not routinely be interpreted as a marker for Epo-induced functional iron deficiency in MDS.
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Affiliation(s)
- Therese Ljung
- Department of Medicine, Division of Hematology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
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26
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Cortesão E, Vidan J, Pereira J, Gonçalves P, Ribeiro ML, Tamagnini G. Onset of X-linked sideroblastic anemia in the fourth decade. Haematologica 2004; 89:1261-3. [PMID: 15477213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
We report the case of a 40-year female who manifested late onset, pyridoxine-refractory X-linked sideroblastic anemia, heterozygous for the first described frameshift ALAS2 mutation, CD506-507 (-C). On presentation she had macrocytic anemia with severe iron overload.
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27
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Jani JC, Gaitonde S, Saunthararajah Y, Ni H. Pathologic quiz case: a 68-year-old man with thrombocytosis and ringed sideroblasts. Essential thrombocythemia with ringed sideroblasts. Arch Pathol Lab Med 2004; 128:815-6. [PMID: 15214840 DOI: 10.5858/2004-128-815-pqcaym] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jigna C Jani
- Department of Pathology, University of Illinois, Chicago 60612, USA.
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28
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29
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Dalamaga M, Karmaniolas K, Chavelas C, Liatis S, Ioannidis P, Matekovits H, Migdalis I. Coexistence of primary refractory anemia with ringed sideroblasts and T cell-lymphoblastic non-Hodgkin lymphoma. Acta Haematol 2004; 111:171-2. [PMID: 15034241 DOI: 10.1159/000076528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2003] [Accepted: 10/27/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Maria Dalamaga
- Department of Internal Medicine, Hematology Section, NIMTS General Hospital, Athens, Greece.
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30
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Li CH, Lam CW, Lee CWA, Kwong NS, Szeto SC. Pearson's syndrome: a rare cause of non-immune hydrops fetalis. Chin Med J (Engl) 2003; 116:1952-4. [PMID: 14986619 DOI: pmid/14986619] [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: 02/08/2023] Open
Affiliation(s)
- Chak Ho Li
- Department of Paediatrics, Tuen Mun Hospital, New Territories, Hong Kong, China.
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31
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Mendek-Czajkowska E, Słomkowski M, Zdebska E, Mokras U, Sikorska A, Maryniak R, Górski T, Zych-Mordzińska J, Bielecka B. Hemoglobin F in primary myelofibrosis and in myelodysplasia. Clin Lab Haematol 2003; 25:289-92. [PMID: 12974718 DOI: 10.1046/j.1365-2257.2003.00537.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our study investigated two groups of adult patients with established diagnoses of primary myelofibrosis (21 patients) and myelodysplastic syndromes (MDS) (21 patients). The objective was to assess fetal hemoglobin (HbF) concentration and to investigate correlations with organomegaly and extramedullary hematopoiesis and with the level of anemia and blood transfusion requirement. In all patients, the diagnosis was confirmed by histopathological examination. Patients with myelofibrosis were investigated by ferrokinetics using 59Fe. The percentage of marrow sideroblasts was assessed in patients with refractory anemia with ringed sideroblasts. Increased values of HbF were found to occur both in patients with myelofibrosis and with MDS, although a higher incidence and higher concentrations were evident in patients with myelofibrosis. Statistically significant increases in HbF concentration were found when there was accompanying organomegaly, as compared to patients without this feature. The average HbF concentration in both groups of patients under study was twice as high in cases with as in those without marrow fibrosis. The difference was statistically significant. Increased HbF levels appear to correlate with extramedullary hematopoiesis. HbF concentration did not correlate with the level of anemia or with requirement for blood transfusion.
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Affiliation(s)
- E Mendek-Czajkowska
- Clinic of Hematology, Institute of Hematology and Blood Transfusion, Warsaw, Poland
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32
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Pérez Sánchez I, Pérez Corrala A, Menarguez Palanca J, Mayayo Crespo M, Escudero Soto A, Pintado Cros T. Sideroblastic anaemia with reactive thrombocytosis versus myelodysplastic/myeloproliferative disease. Leuk Lymphoma 2003; 44:557-9. [PMID: 12688334 DOI: 10.1080/1042819021000037903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The reported incidence of thrombocytosis among cases of refractory anaemia with ring sideroblasts (RARS) may be as high as 15%. We report four additional cases of this association, which appear to be hematologically heterogeneous. One patient clearly represents a case of RARS with reactive thrombocytosis. Two cases have features suggestive of the coincidental occurrence of essential thrombocythemia and RARS. The fourth case could be best classified as a subtype of myelodysplastic/myeloproliferative disease unclassifiable (MDS/MPD U). Only new biological or molecular markers will allow better differentiation between these disorders.
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33
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Urban CH, Deutschmann A, Kerbl R, Lackner H, Schwinger W, Königsrainer A, Margreiter R. Organ tolerance following cadaveric liver transplantation for chronic graft-versus-host disease after allogeneic bone marrow transplantation. Bone Marrow Transplant 2002; 30:535-7. [PMID: 12379895 DOI: 10.1038/sj.bmt.1703688] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 01/29/2002] [Accepted: 06/01/2002] [Indexed: 11/08/2022]
Abstract
A paediatric patient was treated with orthotopic liver transplantation after he developed cirrhosis of the liver due to chronic graft-versus-host disease (GVHD) following allogeneic bone marrow transplantation. His pre-existing chronic GVHD of the skin disappeared and immunosuppressive therapy could be gradually tapered and finally withdrawn 71 months after liver transplantation. Two and a half years after discontinuation of all immunosuppressive therapy, the patient is in excellent condition with neither signs of chronic GVHD nor rejection of the liver graft.
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Affiliation(s)
- C H Urban
- Department of Paediatrics and Adolescence Medicine, University of Graz, Austria
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Abstract
CASE HISTORY AND CLINICAL FINDINGS A 69-year-old woman was admitted because of a normocytic anemia. One year before an acute B19 parvovirus infection had been diagnosed, but the anemia was attributed to intestinal bleeding caused by a dysplastic colonic polyp. However, anemia persisted despite polypectomy. There was an excessive elevation of serum ferritin. ADDITIONAL EXAMINATIONS A bone marrow biopsy and aspirate led to the diagnosis of a myelodysplastic syndrome (pure sideroblastic anemia). Ultrasound demonstrated advanced fibrosis of the liver. Fibrosis in association with severe parenchymatous siderosis was also demonstrated by histology. Analysis of the hemochromatosis gene (B-HFE, nt 845, G/A) was negative. DIAGNOSIS, THERAPY AND CLINICAL COURSE The patient had secondary hemochromatosis due to a myelodysplastic syndrome. An acute infection with parvovirus B19 had been noted at the time of the first admission, one year before MDS was diagnosed. At that time, hemochromatosis had already caused fibrosis of the liver. However, complete regression of organ siderosis was achieved by deferoxamine administration. The myelodysplastic syndrome itself did not show any progression even 7 years after the diagnosis was established. CONCLUSION Our case demonstrates the uncommon association between sideroblastic anemia and secondary hemochromatosis. Acute parvovirus infection may induce severe anemia in myelodysplastic syndromes. In acute B19 parvovirus infections an underlying hematologic disease should be excluded.
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Affiliation(s)
- G-C Sutor
- Abteilung Pneumologie, Hannover, Germany.
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35
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Tchinda J, Volpert S, Neumann T, Kennerknecht I, Ritter J, Büchner T, Berdel WE, Horst J. Novel der(1)t(1;19) in two patients with myeloid neoplasias. Cancer Genet Cytogenet 2002; 133:61-5. [PMID: 11890991 DOI: 10.1016/s0165-4608(01)00505-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cytogenetic studies can be useful in the clinical management of patients with leukemia. They may also give a clue to leukemogenesis and/or pathogenesis. Numerous disease-specific chromosomal aberrations have been and continue to be identified. Translocation (1;19)(q21 through q23;p13.3) involving the long arm of chromosome 1 and the short arm of chromosome 19 is usually associated with acute lymphoblastic leukemia. We found a new translocation involving one virtually identical breakpoint 19p13 and one distinct 1p13 in two cases of myeloid neoplasms. Studies of bone marrow and peripheral blood specimens specified in one of our patients acute myeloid leukemia and in an other myelodysplastic syndrome. Conventional cytogenetics was supplemented by spectral karyotyping (SKY), microdissection, and fluorescence in situ hybridization. Our first case showed a der(1)t(1;19)(p13;p13.1) as the sole chromosomal change. In addition to this translocation, a pericentric inversion within chromosome 10 and with a cryptic t(10;11) were detected by SKY in the second case. Translocation (1;19)(p13;p13.1) may play a role in the leukemogenesis of myeloid diseases.
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Affiliation(s)
- Joëlle Tchinda
- Institut für Humangenetik, Westfälische Wilhelms-Universität, Vesaliusweg 12-14, Münster, Germany.
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Mayes C, Sweeney C, Savage JM, Loughrey CM. Pearson's syndrome: a multisystem disorder. Acta Paediatr 2001; 90:235-7. [PMID: 11236062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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37
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Saunthararajah Y, Molldrem JL, Rivera M, Williams A, Stetler-Stevenson M, Sorbara L, Young NS, Barrett JA. Coincident myelodysplastic syndrome and T-cell large granular lymphocytic disease: clinical and pathophysiological features. Br J Haematol 2001; 112:195-200. [PMID: 11167802 DOI: 10.1046/j.1365-2141.2001.02561.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [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: 11/20/2022]
Abstract
Myelodysplastic syndrome (MDS) and T-cell large granular lymphocytic disease (T-LGL) are bone marrow failure disorders. Successful use of immunosuppressive agents to treat cytopenia in MDS and LGL suggests a common pathophysiology for the two conditions. Of 100 patients with initial diagnoses of either MDS or T-LGL referred to the National Institutes of Health for immunosuppressive treatment of cytopenia, nine had characteristics of both T-LGL and MDS (T-LGL/MDS). Fifteen patients with T-LGL received cyclosporin (CSA) (10 responses). Eight out of nine patients with T-LGL/MDS received CSA (two responses) and one patient received ATG (one response). Of 76 patients with MDS, eight received CSA (one response) and 68 received ATG (21 responses). The response to immunosuppression was significantly lower in patients with T-LGL/MDS and MDS than in patients with T-LGL disease alone (28% vs. 66%, P = 0.01). The proportion of T-helper cells and T-suppressor cells with an activated phenotype (HLA-DR(+)) was increased in patients with T-LGL, T-LGL/MDS and MDS, but the increase in activated T-suppressor cells in patients with T-LGL/MDS was not statistically significant. Autoreactive T cells may suppress haematopoiesis and contribute to the cytopenia in T-LGL and some patients with MDS, leading to T-LGL/MDS. The lower response rate of MDS or T-LGL/MDS to immunosuppression, compared with T-LGL alone, may reflect the older age and intrinsic stem cell abnormalities in MDS and T-LGL/MDS patients.
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MESH Headings
- Adult
- Age Factors
- Aged
- Anemia, Refractory/complications
- Anemia, Refractory/genetics
- Anemia, Refractory/immunology
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/immunology
- Anemia, Sideroblastic/complications
- Anemia, Sideroblastic/genetics
- Anemia, Sideroblastic/immunology
- Female
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, T-Cell/complications
- Leukemia, T-Cell/genetics
- Leukemia, T-Cell/immunology
- Lymphocyte Count
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/immunology
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Regulatory/immunology
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Affiliation(s)
- Y Saunthararajah
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Abstract
OBJECTIVES The syndrome of X-linked sideroblastic anaemia with ataxia is rare, described only twice in the literature. The aim was to obtain clinical neurological and haematological data about this rare syndrome throughout adult life. METHODS A family is described with two affected brothers and two affected maternal uncles. The family was evaluated clinically. Haematological investigations included full blood count, blood film, iron studies, free erythrocyte protoporphyrin (FEP) concentrations and a bone marrow examination where possible. RESULTS Core neurological features included motor delay, ataxia evident from early childhood, and dysarthria. Neurological features were non-progressive until the fifth decade when slow progression became evident. Some family members showed mild spasticity. Patients usually have a mild asymptomatic anaemia or a borderline decreased mean corpuscular volume. Blood film examination showed Pappenheimer bodies. Bone marrow examination showed ring sideroblasts, indicating raised erythrocyte iron. Free erythrocyte protoporphyrin (FEP) concentrations were raised. CONCLUSIONS Haematological features are subtle and can be easily overlooked, and individual patients may not display all the abnormal features. X-linked ataxias are rare and incorrect genetic advice may be given if the diagnostic haematological features of X-linked sideroblastic anaemia are overlooked. Males with early onset ataxia should have a haematological evaluation including a blood film, with a bone marrow examination if abnormal blood count indices and measurement of FEP concentrations raise suspicion. The condition has parallels with Pearson's syndrome and Friedreich's ataxia. All three conditions are associated with mitochondrial iron handling defects and ataxia. The human ATP binding cassette gene (hABC7) is a candidate gene and requires further investigation.
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Affiliation(s)
- K D Hellier
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
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Arenas M, Tovar A, Martínez V, Calduch JV, del Mar Segarra M, Mata B. [Lymphatic tuberculosis with an atypical presentation in a patient with myelodysplastic syndrome: an unusual association]. Enferm Infecc Microbiol Clin 2000; 18:294-6. [PMID: 11075492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Refractory/complications
- Anemia, Refractory/diagnosis
- Anemia, Refractory/drug therapy
- Anemia, Refractory/pathology
- Anemia, Sideroblastic/complications
- Anemia, Sideroblastic/diagnosis
- Anemia, Sideroblastic/drug therapy
- Anemia, Sideroblastic/pathology
- Anti-Bacterial Agents
- Antitubercular Agents/therapeutic use
- Bone Marrow/pathology
- Drug Therapy, Combination/therapeutic use
- Ethambutol/therapeutic use
- Female
- Folic Acid/therapeutic use
- Humans
- Immunocompromised Host
- Isoniazid/therapeutic use
- Rifampin/therapeutic use
- Thyroxine/therapeutic use
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/drug therapy
- Vitamin B Complex/therapeutic use
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41
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Affiliation(s)
- C I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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42
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Abstract
Relapsing polychondritis (RP) is a rare multisystem disorder. We describe two case reports of patients with RP, one of whom developed myelodysplasia subtype refractory anaemia (RA) and the other, refractory anaemia with ringed sideroblasts (RARS). We also review the literature of association between RP and haematological disorders.
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Affiliation(s)
- B Myers
- Queens Medical Centre, Nottingham, UK
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43
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Cruysberg JR. Bilateral zonular cataract associated with the mitochondrial cytopathy of Pearson syndrome. Am J Ophthalmol 1999; 127:243-4. [PMID: 10030587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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44
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Beris P, Samii K, Darbellay R, Zoumbos N, Tsoplou P, Kourakli A, Preud'homme C, Fenaux P. Iron overload in patients with sideroblastic anaemia is not related to the presence of the haemochromatosis Cys282Tyr and His63Asp mutations. Br J Haematol 1999; 104:97-9. [PMID: 10027719 DOI: 10.1046/j.1365-2141.1999.01142.x] [Citation(s) in RCA: 15] [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] [Indexed: 11/20/2022]
Abstract
Forty Caucasian patients with primary acquired sideroblastic anaemia (SA), were investigated for the presence of the Cys282Tyr and/or His63Asp mutation as possible cofactor(s) for iron overload. One patient was heterozygous for the Cys282Tyr mutation and 13 heterozygotes and one homozygote for the His63Asp mutation were found (no difference compared with controls). SA patients with normal codon 63 had a mean ferritin level of 923+/-815 microg/l whereas those with codon 63 mutation had 769+/-577 microg/l (P=0.64). We conclude that ineffective erythropoiesis with no associated mutation in the HFE gene can lead to iron overload in SA patients.
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Affiliation(s)
- P Beris
- Division of Haematology, University Hospitals, Geneva, Switzerland
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45
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Guirado Giménez F, Montoya Villarroya J, Oliván del Cacho MJ, Playán Ariso A, Alcaine Villarroya MJ, Rábano Rodríguez A, Baldellou Vázquez A, López-Pisón J. [A patient with Pearson and Kearns-Sayre syndrome and a common 4.9 Kb deletion of mitochondrial DNA in blood]. An Esp Pediatr 1998; 49:510-2. [PMID: 9949596] [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: 02/10/2023]
Affiliation(s)
- F Guirado Giménez
- Sección de Neuropediatría del Hospital Infantil Miguel Servet de Zaragoza
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46
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Romero MJ, Acín P, Avellaneda C. [Sideroblastic refractory anemia and acute leukemia in Waldenstrom's macroglobulinemia]. Sangre (Barc) 1998; 43:464-5. [PMID: 9868347] [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: 02/09/2023]
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47
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Abstract
Two siblings, a male and a female, had severe axonal neuropathy and sideroblastic anemia. Despite a distinct clinical picture with areflexia, ataxia, hypotonia, optic atrophy, and progressive sensory neural hearing loss, no definite diagnosis could be reached and the older sibling died at 6 years of age of respiratory failure. It is proposed that the two affected siblings have a new form of autosomal-recessive axonal hereditary sensory motor neuropathy.
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Affiliation(s)
- S M Eckhardt
- Great Ormond Street Hospital, London, United Kingdom
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48
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Beauchef A, Siguret V, Yvain F, Andreux MH, Berigaud S, Gaussem P, Andreux JP. [Sideroblastic refractory anemia type myelodysplastic syndrome in a 91-year-old man]. Ann Biol Clin (Paris) 1998; 56:351-4. [PMID: 9754269] [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: 02/08/2023]
Affiliation(s)
- A Beauchef
- Laboratoire d'hématologie, Groupe Hospitalier Charles Foix-Jean Rostand, Ivry-sur-Seine
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49
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Abstract
PURPOSE To report a child with the mitochondrial cytopathy of Pearson syndrome and zonular cataract. METHOD Case report. We describe a 6-year-old boy with Pearson syndrome. RESULTS At age 3 years, the boy developed secondary strabismus caused by bilateral zonular cataract. Subsequently, he underwent successful bilateral cataract extraction with intraocular lens implantation. Postoperative visual acuity with best correction was RE, 20/25 and LE, 20/40. CONCLUSIONS Children with Pearson syndrome should be examined ophthalmologically to rule out zonular cataract and possible amblyopia. Mitochondrial cytopathies such as Pearson syndrome should be included in the differential diagnosis of congenital and early juvenile cataract.
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Affiliation(s)
- C Cursiefen
- Department of Ophthalmology, University Eye Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Germany.
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50
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Shibata K, Shimamoto Y, Nakazato S, Matsuzaki M, Tadano J. Refractory anaemia with ringed sideroblasts concurrent with multiple myeloma--a brief review of the recent literature. Haematologia (Budap) 1997; 28:199-205. [PMID: 9408763] [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: 02/05/2023]
Abstract
The report describes a patient in whom myelodysplastic syndrome and multiple myeloma (MM) were simultaneously present. This patient manifested an IgA-lambda type of MM concurrent with a refractory anaemia with ringed sideroblasts (RARS) without prior therapy. His bicytopenia could not be improved by vitamin B6 regardless of a reduced serum vitamin B6 concentration. A review of the literature suggests that myelodysplastic syndrome (MDS), chronic neutrophilic leukaemia (CNL) and idiopathic myelofibrosis (IMF) are the most frequent disorders associated with MM. The IgA type seems to be associated more commonly with these disorders. The mechanisms responsible for the development of plasma cell proliferation are diverse; the neoplastic transformation of a common progenitor, the involvement of the lymphoplasmacytic system and/or chronic reticuloendothelial stimulation may play a role in the occurrence of such hybrid haematological disorders.
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Affiliation(s)
- K Shibata
- Department of Internal Medicine, Saga Medical School, Japan
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