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Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation.

Abstract：

:Thrombotic microangiopathy (TMA) is a significant complication after hematopoietic stem-cell transplantation (HSCT); however, there is little information on it following reduced-intensity cord blood transplantation (RI-CBT). We reviewed the medical records of 123 adult patients who received RI-CBT at Toranomon Hospital between January 2002 and August 2004. TMA was diagnosed in seven patients based on intestinal biopsy (n = 6) or autopsy results (n = 1). While these patients showed some clinical symptoms such as diarrhea and/or abdominal pain, mental status alterations or neurological disorders were not observed in any of them. Laboratory results were mostly normal at the onset of TMA; >2% fragmented erythrocytes (n = 1), <10 mg/dl haptoglobin (n = 1), and >200 IU/dl lactic dehydrogenase (LD) (n = 4). On endoscopic examination, TMA lesions, consisting of ulcers, erosions, and diffuse exfoliation, were distributed spottily from terminal ileum to rectum. Intestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) colitis were confirmed in five and four patients, respectively. With therapeutic measures including supportive care (n = 4), fresh frozen plasma (n = 1), and a reduction of immunosuppressive agents (n = 1), TMA improved in four patients. The present study demonstrates that intestinal TMA is a significant complication after RI-CBT. Since conventional diagnostic criteria can overlook TMA, its diagnosis requires careful examination of the gastrointestinal tract using endoscopy with biopsy.

journal_name

Bone Marrow Transplant

journal_title

Bone marrow transplantation

authors

Narimatsu H,Kami M,Hara S,Matsumura T,Miyakoshi S,Kusumi E,Kakugawa Y,Kishi Y,Murashige N,Yuji K,Masuoka K,Yoneyama A,Wake A,Morinaga S,Kanda Y,Taniguchi S

doi

10.1038/sj.bmt.1705099

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

517-23

issue

6

eissn

0268-3369

issn

1476-5365

pii

1705099

journal_volume

36

pub_type

杂志文章

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