A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
- haematology (incl blood transfusion)
- renal transplantation
- haematology (drugs and medicines)
- unwanted effects / adverse reactions
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Contributors TB acquired and interpreted the patient data, drafted the article, approved the final version published and agrees to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. RJ revised the article before giving final approval of the version published. PM-C revised the article critically with respect to the haematopathology, before giving final approval of the version published. WT conceived the article and revised it critically before giving final approval of the version published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests WT: part of advisory boards for Daiichi Sankyo, Ablynx and Sanofi; gets speaker's fees from Pfizer, Takeda and Bayer; supports to attend educational meetings from NovoNordisk.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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