Hyposplenism after allogeneic bone marrow transplantation
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IMAGES IN HAEMATOLOGY Hyposplenism after allogeneic bone marrow transplantation A 47-year-old man with acute myeloid leukaemia in second remission underwent allogeneic bone marrow transplantation (BMT) from his human leucocyte antigen (HLA)-identical sister (conditioning: busulphan ⁄ cyclophosphamide ⁄ total body irradiation). He engrafted with grade III graft-versus-host disease (GVHD), which was treated with steroids, cyclosporin A and azathioprine. He suffered from three episodes of recurrent life-threatening pneumococcal septicaemia within the first year. A blood film showed abundant nucleated red cells (top left) and Howell-Jolly bodies (bottom left). Splenic ultrasound was normal, but a colloidal sulphur scintiscan showed absent phagocytic uptake (top right). He was given pneumococcal vaccine and penicillin prophylaxis, and remained well. A computerized tomogram scan 2 years later showed splenic atrophy (bottom right). Hyposplenism is a documented side-effect of GVHD after BMT, with loss of spleen volume shown on serial ultrasound. The experience in coeliac disease and sickle cell anaemia shows that peripheral blood examination and colloidal sulphur scan are two simple and dependable methods for assessment of splenic function. Patients with features of hyposplenism developing after BMT should be identified by peripheral blood examination and given appropriate vaccination and antibiotic precautions to avoid disastrous consequences. Wing Y. Au 1 Shiu K. Ma 2 Kwong K. Wong 3 Departments of 1 Medicine, 2 Pathology and 3 Nuclear Medicine, Queen Mary Hospital, Hong Kong. E-mail: [email protected] British Journal of Haematology, 2002, 117, 488 488 Ó 2002 Blackwell Science Ltd
Transcript of Hyposplenism after allogeneic bone marrow transplantation
IMAGES IN HAEMATOLOGY
Hyposplenism after allogeneic bone marrow transplantation
A 47-year-old man with acute myeloid leukaemia in second remission underwent allogeneic bone marrow transplantation(BMT) from his human leucocyte antigen (HLA)-identical sister (conditioning: busulphan ⁄ cyclophosphamide ⁄ total bodyirradiation). He engrafted with grade III graft-versus-host disease (GVHD), which was treated with steroids, cyclosporin A andazathioprine. He suffered from three episodes of recurrent life-threatening pneumococcal septicaemia within the first year. Ablood film showed abundant nucleated red cells (top left) and Howell-Jolly bodies (bottom left). Splenic ultrasound was normal,but a colloidal sulphur scintiscan showed absent phagocytic uptake (top right). He was given pneumococcal vaccine andpenicillin prophylaxis, and remained well. A computerized tomogram scan 2 years later showed splenic atrophy (bottom right).
Hyposplenism is a documented side-effect of GVHD after BMT, with loss of spleen volume shown on serial ultrasound. Theexperience in coeliac disease and sickle cell anaemia shows that peripheral blood examination and colloidal sulphur scan aretwo simple and dependable methods for assessment of splenic function. Patients with features of hyposplenism developing afterBMT should be identified by peripheral blood examination and given appropriate vaccination and antibiotic precautions toavoid disastrous consequences.
Wing Y. Au1
Shiu K. Ma2
Kwong K. Wong3
Departments of 1Medicine, 2Pathology and 3Nuclear Medicine, Queen Mary Hospital, Hong Kong.E-mail: [email protected]
British Journal of Haematology, 2002, 117, 488
488 � 2002 Blackwell Science Ltd
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