Aplasia medular tratada exitosamente con ciclosporina en un paciente en hemodiálisis crónica

• Jorge Vega S ^[1] ; María de los Angeles Rodríguez S ^[1] ; Alejandro Vásquez G ^[1] ; Carlos Torres F ^[1]
  1. [1] Hospital Naval Almirante Nef

     Hospital Naval Almirante Nef

     Viña del Mar, Chile

     
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 132, Nº. 8, 2004, págs. 989-994
• Idioma: español
• Títulos paralelos:
  • Bone marrow aplasia during hemodialysis successfully treated with cyclosporine. Report of one case
• Enlaces
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• Resumen

  • A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16%, white blood cell count 3.800 mm³ and platelets 11.000 mm³. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43%, white blood cell count 6.600 mm³ and platelets, 150.000 mm³ and did not change during the first year of follow up (Rev Méd Chile 2004; 132: 989-94