PMID: 9535611Apr 16, 1998Paper

Azathioprine-induced megaloblastic anemia with pancytopenia 22 years after living-related renal transplantation

International Journal of Urology : Official Journal of the Japanese Urological Association
C J KimY Nakane

Abstract

Macrocytosis and megaloblastic changes in the bone marrow are frequently seen in renal transplant recipients treated with azathioprine (Az). However, severe anemia is a rare side effect of Az. We recently observed a case of severe megaloblastic anemia with pancytopenia in a renal transplant recipient who had been receiving Az therapy for 22 years. The patient was a 46-year-old woman who had been administered Az and prednisolone at a dose of approximately 1.7 mg/kg and 0.17 mg/kg daily, respectively. A bone marrow aspiration revealed megaloblastic anemia with the depletion of myeloid cells and megakaryocytes. She did not have vitamin B12 or folate deficiency. Therefore, FK506 (tacrolimus), a macrolide produced by Streptomyces tsukubaensis, which acts directly on T cells and is known to have less myelosuppression than Az, was substituted for Az. Although the leukopenia improved, the anemia and thrombocytopenia did not improve in the short term. She developed dyspnea and severe subcutaneous bleeding of the right lower extremity due to knee contusions. Hemodialysis was started to treat her uremic state. Although it was impossible to evaluate the long-term effects of FK506 therapy for the pancytopenia in our case, the conversion fro...Continue Reading

References

May 1, 1992·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·B Vogt, B A Fivush
Mar 1, 1981·Scandinavian Journal of Haematology·U SjögrenT Lindholm

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