My Aplastic Anemia

An 84 year old white male was treated in the Sarasota-Manatee area for more than a decade with cyclosporine for a diagnosis of aplastic anemia.

The patient was transfusion dependent for much of the time he was treated. At the time he presented to me the patient had renal failure with a calculated creatinine clearance of 17. Platelet counts were running in the 10-20,000 range with transfusion dependence for both red blood cells and platelets. The patient was a DNR and pre-registered with the medical examiner. The patient’s complete records were requested multiple times and were not sent to us. The patient came to me for a second opinion stating,

“MY BLOOD COUNTS ARE TERRIBLE AND I NEED TRANSFUSIONS 2 TO 3 TIMES PER WEEK. MY BLOOD COUNTS ARE GETTING WORSE. WHAT CAN YOU DO TO HELP ME?”

[tabs tab1=”Diagnosis” tab2=”Significant Findings” tab3=”Pharmacology” tab4=”Management” tab5=”Comments” tab6=”Patient Update”]
[tab num=1]Per patient history cyclosporine was given for 11 years without a repeat bone marrow examination. Creatinine clearance was less than 20 at the time of initial presentation to me. Baseline platelet count was 14,000 and hemoglobin of 7.6. A repeat bone marrow examination demonstrated that the patient’s correct diagnosis was T-cell chronic lymphocytic leukemia and B-cell non-Hodgkin’s lymphoma. Marrow cellularity was normal for age with no evidence of aplasia.[/tab]
[tab num=2]Patient was being treated with a nephrotoxic agent (cyclosporine) for more than a decade with presumed renal failure due to prolonged cyclosporine use.[/tab]
[tab num=3]Cyclosporine is a nephro-toxic agent which needs to be given for the appropriate indication and with the greatest of care. It is not indicated for the primary treatment of CLL or non-Hodgkin’s Lymphoma.[/tab]
[tab num=4]Cyclosporine was immediately discontinued. The patient was treated with a combination of IV pentostatin,and rituxan, Pentostatin is an antimetabolite. Rituxan is a monoclonal antibody that targets B cell malignancies. He has received intermittent procrit for anemia of renal failure. The patient has been under our care for about 18 months. He has not received any transfusions in more than 9 months. He has not received any chemotherapy or biologic treatment for his CLL or non-Hodgkin’s lymphoma in more than 6 months.[/tab]
[tab num=5]Most recent wbc 3400, hemoglobin 10.2, platelet count 69,000.[/tab]
[tab num=6]Patient is no longer a DNR. His golf game is improving and he is enjoying the company of his wife.[/tab]
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