Azathioprine-Induced Severe Bone Marrow Suppression
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Abstract
Aplastic anemia is characterized by bone marrow failure and pancytopenia. It could be due to autoimmune disorders, radiation, drugs, or chemicals. Drugs that mostly cause aplastic anemia include chloramphenicol, non-steroidal anti-inflammatory drugs, antiepileptic drugs, gold salts, and antithyroid drugs. Clinical sign and symptoms often result from pancytopenia that includes signs of anemia and bleeding. In some patients, fever and sepsis are seen that are due to neutropenia. Azathioprine is a purine antimetabolite, an immunosuppressive drug that causes myelosuppression and pancytopenia, especially in patients who have some degrees of TPMT (Thiopurine Methyltransferase) activity. We present a patient who admitted to our hospital with fever and pancytopenia and a history of recent azathioprine treatment. Because of delay in the recovery of pancytopenia, she was suspected of aplastic anemia, and bone marrow aspiration and biopsy were done for her.
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[3] Stolk JN, Boerbooms AM, de Abreu RA, de Koning DG, van Beusekom HJ, Muller WH, et al. Reduced thiopurine methyltransferase actvity and development of side effects of azathioprine treatment in patents with rheumatoid arthrits. Arthrits & Rheumatsm: Ofcial Journal of the American College of Rheumatology. 1998; 41(10):1858-66. [DOI:10.1002/1529- 0131(199810)41:103.0.CO;2-8]
[4] Weinzierl EP, Arber DA. Bone marrow evaluaton in new-onset pancytopenia. Human Pathology. 2013; 44(6):1154-64. [DOI:10.1016/j. humpath.2012.10.006]
[5] Devit KA, Lunde JH, Lewis MR. New onset pancytopenia in adults: A review of underlying pathologies and their associated clinical and laboratory fndings. Leukemia & Lymphoma. 2014; 55(5):1099-105. [DOI:10.3109/10428194.2013.821703]
[6] Valent P. Low blood counts: Immune mediated, idiopathic, or myelodysplasia. ASH Educaton Program Book. 2012; 2012(1):485-91. [DOI:10.1182/asheducato]
[7] Jha A, Sayami G, Adhikari RC, Panta AD, Jha R. Bone marrow examinaton in cases of pancytopenia. Journal of Nepal Medical Associaton. 2008; 47(169):12-7. [DOI:10.31729/jnma.209]
[8] Young NS, Calado RT, Scheinberg P. Current concepts in the pathophysiology and treatment of aplastc anemia. Blood. 2006; 108(8):2509-19. [DOI:10.1182/blood-2006-03-010777]
[9] Gabreyes AA, Abbasi HN, Forbes KP, McQuaker G, Duncan A, Morrison I. Hypocupremia associated cytopenia and myelopathy: A natonal retrospectve review. European Journal of Haematology. 2013; 90(1):1-9. [DOI:10.1111/ejh.12020]
[10] Sabel AL, Gaudiani JL, Statland B, Mehler PS. Hematological abnormalites in severe anorexia nervosa. Annals of Hematology. 2013; 92(5):605-13. [DOI:10.1007/s00277-013-1672-x]
[11] Shimamura A, Alter BP. Pathophysiology and management of inherited bone marrow failure syndromes. Blood Reviews. 2010; 24(3):101-22. [DOI:10.1016/j.blre.2010.03.002]
[12] Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone marrow examinaton in cases of pancytopenia. Journal of Nepal Medical Associaton. 2008; 47(169):12-7. [PMID]
[13] Schneeweiss S, Hasford J, Götler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: A longitudinal populaton-based study. European Journal of Clinical Pharmacology. 2002; 58(4):285-9. [DOI:10.1007/s00228-002-0467 0]
[14] Elion GB. The purine path to chemotherapy. Science. 1989; 244(4900):41-7. [DOI:10.1126/science.2649979]
[15] Belmont MH. Pharmacology and side effects of azathioprine when used in rheumatc diseases. Waltham, Massachusets: UpToDate; 2015.
[16] Hadda V, Pandey BD, Gupta R, Goel A. Azathioprine induced pancytopenia: A serious complicaton. Journal of Postgraduate Medicine. 2009; 55(2):139-40. [DOI:10.4103/0022-3859.52849]
[17] Weinshilboum RM, Sladek SL. Mercaptopurine pharmacogenetics: Monogenic inheritance of erythrocyte thiopurine methyltransferase actvity. American Journal of Human Genetcs. 1980; 32(5):651-62. [PMID] [PMCID]
[18] Anstey A, Lennard L, Mayou SC, Kirby JD. Pancytopenia related to azathioprine--an enzyme defciency caused by a common genetc polymorphism: A review. Journal of the Royal Society of Medicine. 1992; 85(12):752-6. [PMID] [PMCID]
| Files | ||
| Issue | Vol 4 No 1 (2019): Winter | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v4i1.1300 | |
| Keywords | ||
| Aplastic anemia Azathioprine Pancytopenia | ||
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How to Cite
1.
Ghalamkari M, Karimpour Reihan S, Khajavi Rad N, Abbaszadeh M. Azathioprine-Induced Severe Bone Marrow Suppression. CRCP. 2019;4(1):9-13.
