Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
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Severe anemia caused by secondary myelofibrosis in a patient with angioimmunoblastic peripheral T-cell lymphoma

  • Jo, Jaemin (Department of Internal medicine, Jeju National University School of Medicine) ;
  • Kang, Jeong Ho (Department of Emergency Medicine, Jeju National University School of Medicine)
  • Received : 2020.07.15
  • Accepted : 2020.08.06
  • Published : 2020.12.31
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Abstract

Bone marrow failure, such as aplastic or myelophthisic anemia, can occur due to an underlying lymphoid malignancy and cause life-threatening events. A 58-year-old man diagnosed with angioimmunoblastic T-cell lymphoma had recently visited the emergency department because of an altered level of consciousness caused by acute severe anemia. The laboratory findings were strongly suggestive of bone marrow failure syndrome. Bone marrow examination was immediately performed and, subsequently, dexamethasone was initiated to control the underlying lymphoma. Intravenous immunoglobulin was also administered in combination due to combined immune hemolytic anemia and thrombocytopenia. Bone marrow examination revealed a packed marrow with marked fibrosis and lymphoma involvement. A diagnosis of secondary myelofibrosis related to the underlying lymphoma was made, and sequential combination chemotherapy was introduced despite the presence of severe anemia and thrombocytopenia. After combination chemotherapy, his hematologic profile and underlying lymphoma improved. Better understanding of various hematologic manifestations and knowledge of the rare condition of lymphoma are essential for appropriate diagnostic approaches and treatment.

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References

  1. Swenson KK, Rose MA, Ritz L, Murray CL, Adlis SA. Recognition and evaluation of oncology-related symptoms in the emergency department. Ann Emerg Med 1995;26:12-7. https://doi.org/10.1016/S0196-0644(95)70231-8
  2. Vieth JT, Lane DR. Anemia. Emerg Med Clin North Am 2014;32:613-28. https://doi.org/10.1016/j.emc.2014.04.007
  3. Blackman SC, del Rey JAG. Hematologic emergencies: acute anemia. Clin Pediatr Emerg Med 2005;6:124-37. https://doi.org/10.1016/j.cpem.2005.06.001
  4. Long B, Koyfman A. Emergency medicine evaluation and management of anemia. Emerg Med Clin North Am 2018;36:609-30. https://doi.org/10.1016/j.emc.2018.04.009
  5. Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol 2013;139:9-29. https://doi.org/10.1309/AJCP50AEEYGREWUZ
  6. Lunning MA, Vose JM. Angioimmunoblastic T-cell lymphoma: the many-faced lymphoma. Blood Adv 2017;129:1095-102. https://doi.org/10.1182/blood-2016-09-692541
  7. Mosalpuria K, Bociek RG, Vose JM. Angioimmunoblastic T-cell lymphoma management. Semin Hematol 2014;51;52-8. https://doi.org/10.1053/j.seminhematol.2013.11.008
  8. De Leval L, Gisselbrecht C, Gaulard P. Advances in the understanding and management of angioimmunoblastic T-cell lymphoma. Br J Haematol 2010;148:673-89. https://doi.org/10.1111/j.1365-2141.2009.08003.x
  9. Dogan A, Attygalle AD, Kyriakou C. Angioimmunoblastic T-cell lymphoma. Br J Haematol 2003;121:681-91. https://doi.org/10.1046/j.1365-2141.2003.04335.x
  10. Meadows LM, Rosse WR, Moore JO, Crawford J, Laszlo J, Kaufman RE. Hodgkin's disease presenting as myelofibrosis. Cancer 1989;64:1720-6. https://doi.org/10.1002/1097-0142(19891015)64:8<1720::AID-CNCR2820640828>3.0.CO;2-L
  11. Takai K, Sanada M. Peripheral T-cell lymphoma initially presenting as secondary myelofibrosis. Rinsho Ketsueki 1989;30:2199-204.
  12. Uehara E, Tasaka T, Matsuhashi Y, Fujita M, Tamura T, Shimoura Y, et al. Peripheral T-cell lymphoma presenting with rapidly progressing myelofibrosis. Leuk Lymphoma 2003;44:361-3. https://doi.org/10.1080/1042819021000029966