losartan-potassium and Thymoma

Immune-mediated acquired disorders of erythropoiesis can result in pure red cell aplasia or ineffective erythropoiesis. Erythropoiesis can be suppressed or impaired by humoral or cellular mechanisms. In vitro inhibition of erythroid colony growth by humoral factors or lymphocytes is a strong argument for the immune origin of the disease. Classical aetiologies are thymoma and hematological malignancies such as chronic lymphocytic leukaemia. Clonal proliferation of T cells has also been incriminated. Recently, acquired circulating autoantibodies directed against erythropoietin have been detected in a case of pure red cell aplasia. Autoimmune mechanisms have also been suggested in two dyserythropoietic syndromes recently described.

Topics: Anemia; Autoimmune Diseases; Cell Division; Erythropoiesis; Erythropoietin; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Red-Cell Aplasia, Pure; T-Lymphocytes; Thymoma

Pure red cell aplasia is a selective aplasia of the marrow erythroid cells. Unlike aplastic anemia, the marrow has a normal cellularity and the patients generally have normal leukocyte and platelet blood counts. The congenital form of the disease occurs in the firlst 1 1/2 years of life and is often responsive to corticosteroids. The acquired form may be secondary to infections, drugs, chemicals, or hemolytic anemia (aplastic crisis). In these cases it is often acute and self-limited with cessation of the infection or drug ingestion. It may also be secondary to systemic lupus erythematosus, rheumatoid arthritis, acute severe renal failure, severe nutritional deficiency, or diverse neoplasms, and may remit with treatment of the primary condition. When a thymoma is present, it should be resected since a remission is produced in 29 per cent of these patients. The remaining patients have an acquired primary form of the disease that tends to be chronic and in some cases may have an immune pathogenesis. A cytotoxic immunoglobulin inhibitor of the marrow erythroid cells or erythropoietin has been described and these patients may respond to prednisone and/or to cytotoxic immunosuppressive drugs such as cyclophosphamide and 6-mercaptopurine. Pure red cell aplasia appears to be more common than the literature has revealed and has stimulated much investigation into an immune pathogenesis for marrow failure.

Topics: Acute Kidney Injury; Anemia, Aplastic; Antilymphocyte Serum; Arthritis, Rheumatoid; Blood Cell Count; Blood Transfusion; Cyclophosphamide; Deficiency Diseases; Erythropoietin; Humans; Immune System Diseases; Infections; Lupus Erythematosus, Systemic; Mercaptopurine; Prednisone; Remission, Spontaneous; Splenectomy; Thymoma; Thymus Neoplasms

Topics: Adult; Anemia, Aplastic; Animals; Antibodies, Antinuclear; Antigen-Antibody Complex; Bone Marrow; Bone Marrow Cells; Child, Preschool; Cyclophosphamide; Erythrocytes, Abnormal; Erythropoiesis; Erythropoietin; Heme; Humans; Immunoglobulin G; Infant; Mercaptopurine; Prednisone; Stimulation, Chemical; Thymectomy; Thymoma

To summarize the clinical characteristics of acquired pure red cell aplasia (PRCA) patients diagnosed in our hospital in the last 10 years.. The clinical features, immune state and treatment response of acquired PRCA patients diagnosed in our hospital from January 2007 to January 2017 were retrospectively analyzed.. The results showed that thymoma (13.21%) and parvovirus B19 (11.32%) were the most common causes for secondary PRCA. Ferritin (Fer) levels and erythropoietin (EPO) levels were increased in PRCA patients. The total CR and PR rate of immunosuppressive therapy in our studies was 68.29% and 12.20%, respectively. Patients with EPO level >400 U/L and Fer level >200 ng/ml had significantly lower CR rate than others. The patients with EPO level >400 U/L also had longer hemoglobin recovery time than patients with EPO level ≤400 U/L. Patients treated with corticosteroids (CS) + cyclosporine A (CsA) had lower relapse rate compared to the CS group (29.17% vs. 80.00%, P < .05).. Our data showed that patients with PRCA had high EPO and Fer levels. Thymoma and viral infections are the most common causes for secondary PRCA. The CS+ CsA group had lower relapse rate than CS group although response rate was similar. Increased EPO and Fer levels might be the negative factors for prognosis of acquired PRCA.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Erythropoietin; Female; Humans; Male; Middle Aged; Parvoviridae Infections; Parvovirus B19, Human; Red-Cell Aplasia, Pure; Retrospective Studies; Thymoma

Thymoma is a type of rare tumor in the thymus gland, and among patients with thymoma, less than 10% will develop pure red cell aplasia (PRCA), whereas less than 5% of patients with PRCA have a thymoma. The optimal approach for PRCA in thymoma is immunosuppressive therapy, such as steroids, cyclosporine, and human antithymocyte globulin.. A sixty-one-year-old male was diagnosed with thymoma with PRCA after he complained fatigue, tinnitus, and weakness for 1 month, he received therapy with recombinant erythropoietin (rhEPO) for 1 month after the tumor was totally resected and readmitted with pulmonary embolism and received anticoagulation therapy with enoxaparin for 3 months.. Thymoma, pure red cell aplasia, pulmonary embolism.. He received cyclosporine A, prednisone and rhEPO treatment. Two months after the thymectomy and postoperative radiation, he was readmitted with pulmonary embolism.. Thymoma and pulmonary embolism become complete response (CR), PRCA become partial response (PR).. Clinicians should be alert to the possibility of the increased risk of thrombosis induced by rhEPO when it used to treat PRCA associated with thymoma. If other medication is effective for managing PRCA, rhEPO should be avoided.

Topics: Erythropoietin; Hematologic Agents; Humans; Male; Middle Aged; Pulmonary Embolism; Recombinant Proteins; Red-Cell Aplasia, Pure; Thymoma; Thymus Neoplasms

We describe the first reported case, in an 82-year-old man, of erythrocytosis caused by an erythropoietin (EPO)-producing thymic carcinoma. The patient underwent computed tomography-guided fine-needle aspiration of a 6-cm anterior mediastinal mass, and histological findings revealed thymic squamous cell carcinoma. The existence of EPO was confirmed immunohistochemically using the tumor tissue. Postoperative clinical improvement of erythrocytosis and the decline of EPO suggest a paraneoplastic nature of erythrocytosis as seen in this patient.

Topics: Aged, 80 and over; Biopsy, Fine-Needle; Carcinoma, Squamous Cell; Erythropoietin; Humans; Immunohistochemistry; Male; Paraneoplastic Syndromes; Phlebotomy; Polycythemia; Thymectomy; Thymoma; Thymus Neoplasms; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

An 88-year old Japanese female with pure red cell aplasia was treated safely and effectively by a combination of thymectomy, cyclosporin A, and erythropoietin. The thymoma was histologically classified as lymphocytic type or cortical type, which are uncommon in cases of a thymoma accompanied by pure red cell aplasia. Immunohistochemical analysis of the thymoma and bone marrow revealed a predominance of CD8(+) cells. Thymectomy alone was ineffective, but cyclosporin A treatment subsequent to thymectomy was safe and effective and resulted in the disappearance of a Vbeta12 bearing T-cell clone in the bone marrow. Additional treatment with erythropoietin enhanced the effects of cyclosporin A and restored the patient's hemoglobin to normal levels. The beneficial effect of cyclosporin A may be attributed not to a broad immunomodulatory effect, but to a local effect on a limited T-cell subset.

Topics: Aged, 80 and over; Bone Marrow Cells; Cyclosporine; Erythropoietin; Female; Humans; Recombinant Proteins; Red-Cell Aplasia, Pure; Thymectomy; Thymoma

Systemic disorders, often immune in nature, can sometimes be associated with the presence of thymic pathology. Thymic enlargement due to lymphoid hyperplasia or thymoma is a common occurrence in patients with myasthenia gravis. In patients with pure red cell aplasia, at least 10% to 15% of patients are found to have thymoma, usually of spindle cell or medullary type. Pure red cell aplasia with demonstrable thymic enlargement due to lymphoid follicular hyperplasia is distinctly unusual, and has not been previously reported. The authors report such a case developing in a patient with end-stage renal failure maintained on hemodialysis and erythropoietin therapy. Because the red cell aplasia resolved after thymectomy, the disease process was considered etiologically related to the reactive lymphoid hyperplasia.

Topics: Adult; Drug Resistance; Erythropoietin; Female; Humans; Hyperplasia; Kidney Failure, Chronic; Red-Cell Aplasia, Pure; Thymoma; Thymus Gland

AKR/O mice were used as a model for studying the pathogenesis of the anaemia accompanying leukaemia/lymphoma. The leukaemia incidence was 87%. Median age at diagnosis was 11.3 months. At diagnosis most of the mice had normal leukocyte counts. Clinically the mice divided into subgroups depending on the relative organ involvement: 1) thymoma group (n = 98), 2) spleen group (n = 144), 3) combined group (n = 27) and 4) mice with moderate organ changes (n = 216). Mice of group 1 were younger than the others, had a rapidly progressive disease, normal to elevated packed cell volume (PCV), and plasma erythropoietin (Epo) was normal or increased. Mice of group 2 were usually anaemic with high plasma Epo estimates and often elevated reticulocyte counts. Group 4 was the oldest group. Some of these mice were severely affected haematologically. Overall there was an inverse relation between PCV and plasma Epo estimate, indicating a normal Epo response to anaemia. In all groups increasing spleen size was associated with increased severity of anaemia and increased reticulocyte counts. The association between anaemia, elevated reticulocyte counts and spleen enlargement suggests haemolysis as a mechanism for anaemia, and also raises the question of compensatory spleen erythropoiesis.

Topics: Age Factors; Anemia; Animals; Erythropoietin; Female; Hematologic Tests; Incidence; Leukemia, Experimental; Lymphoma; Male; Mice; Mice, Inbred AKR; Spleen; Statistics as Topic; Thymoma; Thymus Gland; Thymus Neoplasms

The combination of aplastic anaemia and thymona was observed in a 49-year old woman. Concomitant with severe normochromic anaemia and reticulocytopenia was a cell-rich bone marrow smear in which erythropoietic precursors were almost absent. Immunological phenomena could not be demonstrated. The erythropoietin level was maximally increased. Pathological anatomy typically revealed a predominantly spindle-cell thymonal with only minor capsular invasion.

Topics: Anemia, Aplastic; Bone Marrow Examination; Erythrocyte Count; Erythropoietin; Female; Humans; Middle Aged; Reticulocytes; Thymoma; Thymus Neoplasms

Three cases of adult pure red cell aplasia (PRCA) ARE REPORTED. All patients proved refractory to various combinations of androgens and corticosteroids. The first case, harboring a thymoma, showed a complete clinical remission following cyclophosphamide therapy. The second and third responded similarly to either a combined cyclophosphamide + antilymphocyte globulin (ALG) treatment or to ALG administration preceded by a small dosage of cyclophosphamide, which had proved ineffective when administered alone. Serum IgG inhibitors to erythropoiesis were demonstrated in all cases by means of in vivo and/or in vitro techniques. The inhibitor(s), although directed against the erythroid marrow in both the first and third patients (PRCA type A), apparently functioned as an antibody to circulating erythropoientin (Ep) in the second case (PRCA type B). The inhibitor(s) was always absent in postremission samples. Additionally, experimental models for both types of human PRCA were established in normal rodents. The present studies support the contention that adult PRCA is an autoimmune disease. The therapeutic role of cytotoxic-immunodepressive agents in PRCA patients is confirmed. It is emphasized that ALG may represent an additional therapeutic tool in cases resistant to cyclophosphamide and/or steroids. In addition, cyclophosphamide proved effective in a patient harboring a thymoma not amenable to surgery. Finally, it is postulated that IgG serum autoantibodies, directed against either an early erythroid precursor (PRCA type A) or, more rarely, circulating Ep (PRCA type B), play a major role in the pathogenesis of the disease.

Topics: Aged; Anemia, Aplastic; Antibodies, Antinuclear; Antilymphocyte Serum; Autoantibodies; Blood Transfusion; Bone Marrow Examination; Cyclophosphamide; Dexamethasone; Diabetic Coma; Erythrocytes; Erythropoietin; Female; Heart Failure; Hematocrit; Hepatitis; Humans; Immunoglobulin G; Iron; Male; Middle Aged; Radiography, Thoracic; Sarcoma, Kaposi; Serum Globulins; Skin Manifestations; Thymoma

Topics: Anemia; Bone Marrow; DNA; Erythropoiesis; Erythropoietin; Heme; Humans; Immunoglobulin G; In Vitro Techniques; Iron Radioisotopes; Lymphoma, Non-Hodgkin; Male; RNA; Thymidine; Thymoma; Tritium

Topics: Anemia, Aplastic; Erythropoietin; Humans; Male; Middle Aged; Thymectomy; Thymoma; Thymus Neoplasms

Topics: Anemia, Aplastic; Animals; Black People; Blood Proteins; Chromatography; Erythrocytes; Erythropoiesis; Erythropoietin; Female; Humans; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin G; Iron Isotopes; Mice; Polycythemia; Rodent Diseases; Thymectomy; Thymoma

Topics: Acute Disease; Anemia, Aplastic; Animals; Biological Assay; Bone Marrow; Bone Marrow Cells; Bone Marrow Diseases; Erythropoiesis; Erythropoietin; gamma-Globulins; Hodgkin Disease; Humans; Iron Isotopes; Leukemia; Mediastinal Neoplasms; Mice; Osteosarcoma; Thymoma

Topics: Blood Transfusion; Bone Marrow; Erythropoiesis; Erythropoietin; Female; Humans; Mediastinal Neoplasms; Middle Aged; Neutrophils; Postoperative Complications; Prednisone; Pyelonephritis; Radiography; Thymectomy; Thymoma; Thymus Gland