SANDRA KURTIN, PhD, ANP-C, AOCN®
University of Arizona and University of Arizona Cancer Center
We are pleased to offer more real-world case studies this month—one for each of the four Class Categories, to bring the content to life.
The Autoimmune Cytopenias case study highlights clinical pearls in the use of steroids and rituximab for warm autoimmune hemolytic anemia, plus tips for optimizing supportive care.
The Bone Marrow Failure Disorders case study describes development of a second bone marrow disorder in an older patient originally treated with anti-thymocyte globulin (ATG), cyclosporine (CSA), and eltrombopag for aplastic anemia (AA). Prior to receiving ATG/CSA, the patient had been passing dark urine in the morning and was experiencing severe joint and muscle pain. He was ultimately diagnosed with paroxysmal nocturnal hemoglobinuria (PNH). The pearl here is that PNH can occur in conjunction with other bone marrow disorders. While the PNH clone in AA may be near normal when first tested (due to the aplastic marrow), once normal hematopoiesis is restored following successful treatment of AA the clone can expand to cause some of the complications outlined in this case.
The case study for the Hemoglobinopathies pillar offers excellent tips for management of menorrhagia and secondary acute anemia in young women with sickle cell disease.
Finally, in Hereditary/Acquired Bleeding Disorders, the importance of multidisciplinary management is underscored in a discussion of compartment syndrome in a young man with severe hemophilia A. This case highlights the importance of comprehensive specialty care for patients with rare bleeding disorders.
As always, please share this resource with your colleagues, and feel free to contact me with comments or suggestions.
American Journal of Perinatology
HemOnc Today [Healio]
Scientific Reports [Nature Research]