Fernando Hernández

Autoimmune Thrombocytopenia Associated with Hepatitis C Virus Infection

We have retrospectively analyzed a series of 19 patients with hepatitis C virus (HCV) infection and chronic thrombocytopenia not attributable to hypersplenism or to other causes. Antiplatelet antibodies were present in 81% of cases. Response to prednisone was observed in 6 of 7 patients and 1 of 3 patients responded to intravenous immunoglobulins. No case of reactivation of liver disease was observed during or after therapy. We consider that the possibility of an underlying mechanism should be evaluated in thrombocytopenic patients with HCV infection who do not present hypersplenism. These patients could benefit from steroid treatment.

Favourable effect of the combination of acute and chronic graft-versus-host disease on the outcome of allogeneic peripheral blood stem cell transplantation for advanced haematological malignancies.

To assess the influence of graft‐versus‐host disease (GVHD) on the outcome of patients with advanced haematological malignancies (AHM) who received a primary, unmodified allogeneic peripheral blood progenitor cells transplant (allo‐PBT) from a human leucocyte antigen (HLA) identical sibling donor, we analysed 136 patients with myeloid neoplasms (nu2003=u200370) or lymphoproliferative disorders (nu2003=u200366), transplanted at 19 Spanish institutions. Median age was 35u2003years (range 1–61). The cumulative incidence of relapse for all patients was 34% (95% CI, 26–42%), 41% (95% CI, 33–49) for patients without GVHD and 14% (95% CI, 3–25) (Pu2003=u20030·001) for patients with acute and chronic GVHD. After a median follow‐up of 11u2003months (range 2–49), 60 (44%) patients remained alive with an actuarial probability of overall survival and disease‐free survival (DFS) at 30u2003months of 31% (95% CI, 21–41%) and 28% (95% CI, 17–39%) respectively. In patients surviving >u200a100u2003d, the low incidence of relapse in those with acute and chronic GVHD led to a DFS of 57% (95% CI, 38–76%) compared with a DFS of 34% (95% CI, 17–51%) in the remaining patients (Pu2003=u20030·03). Our results indicate a reduced incidence of relapse for patients with AHM receiving an unmodified allo‐PBT and developing acute and chronic GVHD, which results in an improved DFS.

Auto-immune haemolytic anaemia in ulcerative colitis: report of three cases.

Dr. Fernando Hernández, Hospital General Universitario, Servicio de Hematologia, Avenida Tres Cruces s/n, E-46014 Valencia (Spain) Auto-immune haemolytic anaemia (AIHA) is a rare but severe complication of ulcerative colitis (UC) occurring in fewer than 1% of cases [1-4]. We present 3 cases of AIHA associated with UC. Case 1 A 31-year-old man with a 10-year history of UC was admitted to the hospital in December 1992 for total proctocolectomy because of persistent colitis. A subtotal colectomy was performed 9 years before. On admission, his haemoglobin (Hb) level was 10.7 g/dl; leucocyte and platelet counts were normal. Reticulocyte count was 304 × 109/1, bilirubin 1.6 mg/dl, haptoglobin 0.23 g/l (normal value 1-2) and LDH 525 U/l (normal value 150-450). The direct antiglobulin test (DAT) was positive (anti-IgG), indirect antiglobulin test and eluate were also positive. After 7 days prednisone treatment (1 mg/kg/day) his Hb rose to 13.8 g/dl. The patient underwent total proctocolectomy in January 1993. Steroids were reduced gradually and stopped in February 1993. Despite not having received treatment for 4 months, he felt perfectly well and his Hb level was 15 g/dl. He still had a weakly positive DAT. Case 2 A 39-year-old woman was diagnosed as having UC in 1986. In October 1989, she was admitted to the hospital with acute haemolytic anaemia. Her Hb level was 6.7 g/dl, reticulocyte count was 196 × 109/1, bilirubin 3.2 mg/l, haptoglobin 0 g/l and DAT was positive (anti-IgG). Indirect antiglobulin test and eluate were positive. The patient was started on 2 mg/kg/day of prednisone, and her Hb rose to 12.7 g/dl over 3 months. Steroids were discontinued but DAT remained positive although weaker than previously.