Yang XD, Ju B, Xu J, Xiu NN, Sun XY, Zhao XC. Glucocorticoid-induced thrombotic microangiopathy in paroxysmal nocturnal hemoglobinuria: A case report and review of literature. World J Clin Cases 2023; 11(8): 1799-1807 [PMID: 36970013 DOI: 10.12998/wjcc.v11.i8.1799]
Corresponding Author of This Article
Xi-Chen Zhao, MD, Chief Physician, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, No. 9 Huangpujiang Road, Qingdao 266555, Shandong Province, China. zhaoxichen2003@163.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Dong Yang, Bo Ju, Jia Xu, Nuan-Nuan Xiu, Xiao-Yun Sun, Xi-Chen Zhao, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Author contributions: Zhao XC developed the idea; Yang XD, Ju B and Xu J analyzed the data and drafted the manuscript; Yang XD, Ju B, Xu J and Xiu NN participated in the treatment; Sun XY supervised the treatment; and Zhao XC revised and approved the final manuscript; all authors have read and approved the final version of the manuscript.
Supported bySpecialized Scientific Research Fund Projects of The Medical Group of Qingdao University, No. YLJT20201002.
Informed consent statement: Informed written consent was obtained from the patient for publishing this case report and any accompanying laboratory data.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial license (CC BY-NC 4.0), which permits others to distribute, remix, adapt, build upon this work noncommercially and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. Please see https://creativecommons.org/Licenses/bync/4.0/
Corresponding author: Xi-Chen Zhao, MD, Chief Physician, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, No. 9 Huangpujiang Road, Qingdao 266555, Shandong Province, China. zhaoxichen2003@163.com
Received: November 7, 2022 Peer-review started: November 7, 2022 First decision: November 25, 2022 Revised: December 2, 2022 Accepted: February 8, 2023 Article in press: February 8, 2023 Published online: March 16, 2023 Processing time: 119 Days and 19 Hours
Core Tip
Core Tip: Glucocorticoid-associated thrombotic microangiopathy has rarely been reported. Here, we report a patient with paroxysmal nocturnal hemoglobinuria whose hematological parameters worsened during methylprednisolone treatment, and increasing methylprednisolone doses further exacerbated the cytopenia. Observation of platelet transfusion refractoriness suggested the possibility of thrombotic microangiopathy development. Significant hematological improvement was achieved after discontinuation of methylprednisolone treatment, confirming that methylprednisolone treatment acted as the triggering factor to promote platelet aggregation within the microcirculation. Given the wide use of glucocorticoids in clinical practice and the high incidence of thrombocytopenia during glucocorticoid treatment, particular attention should be given to this potentially fatal complication.
