Difficulties in diagnosing paroxysmal nocturnal hemoglobinuria in a municipal internal disease hospital
- Authors: Zinnatullina A.R.1, Ishmurzin G.P.1
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Affiliations:
- Kazan State Medical University
- Issue: Vol 13, No 1 (2022)
- Pages: 118-122
- Section: Case reports
- URL: https://journals.rcsi.science/clinpractice/article/view/89570
- DOI: https://doi.org/10.17816/clinpract89570
- ID: 89570
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Abstract
Background: The purpose of this work is to present a case of paroxysmal nocturnal hemoglobinuria in the clinical practice of an internist for the purpose of differential diagnosis with other diseases with the jaundice syndrome in a city hospital.
Clinical case description: Patient H., 51-year-old, was seen at the emergency department of the city hospital due to the periodic appearance of jaundice with dark-colored urine and fever. The physical and laboratory examination methods revealed an enlargement of the spleen, signs of mild hemolytic anemia, severe thrombocytopenia, a significant increase in the markers of cytolysis and cholestasis. Proteinuria and cylindruria were noted in the urine analysis. In terms of a differential diagnosis, Gilbert’s syndrome, viral hepatitis, hemorrhagic fever were considered.
Conclusion: Based on the data obtained, hemolytic and uremic syndromes were suspected. A therapy with iron preparations, vitamin B12, infusions of glucose and saline was applied with the positive clinical and laboratory dynamics. GPI-linked glycoproteins were determined on the surface of red blood cells (CD59), neutrophils (CD 24/FLAER), and monocytes by FLAER-/CD14 flow cytometry, which confirmed the diagnosis of paroxysmal nocturnal hemoglobinuria.
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##article.viewOnOriginalSite##About the authors
Aigul R. Zinnatullina
Kazan State Medical University
Author for correspondence.
Email: aigoul-zinnatullina.rust@mail.ru
ORCID iD: 0000-0003-1974-1071
SPIN-code: 9336-7331
Assistant Lecturer
Russian Federation, 49, Butlerova str., Kazan, 420012Gennady P. Ishmurzin
Kazan State Medical University
Email: ishm08@mail.ru
ORCID iD: 0000-0002-0962-5790
SPIN-code: 2870-3350
MD, PhD, Assistant Professor
Russian Federation, 49, Butlerova str., Kazan, 420012References
- Rosse WF, Ware RE. The molecular basis of paroxysmal nocturnal hemoglobinuria. Blood. 1995;86(9):3277–3286.
- Rother R, Bell L, Hillmen P, et al. The clinical sequealae of intravascular hemolysis and extracellular plasma hemoglobin. JAMA. 2005;293(13):1653–1662. doi: 10.1001/jama.293.13.1653
- Yu F, Du Y, Han B. A comparative analysis of clinical characteristics of patients with paroxysmal nocturnal hemoglobinuria between Asia and Europe/America. Int J Hematol Springer. 2016;103(6):649–654. doi: 10.1007/s12185-016-1995-1
- Кулагин А.Д., Лисуков И.А., Птушкин В.В., и др. Национальные клинические рекомендации по диагностике и лечению пароксизмальной ночной гемоглобинурии // Онкогематология. 2014. Т. 9, № 2. С. 20–28. [Kulagin AD, Lisukov IA, Ptushkin VV, et al. National clinical guidelines for the diagnosis and treatment of paroxysmal nocturnal hemoglobinuria. Oncohematology. 2014; 9(2):20–28. (In Russ).] doi: 10.17650/1818-8346-2014-9-2-20-28
- Hillmen P, Lewis S, Bessler M, et al. Natural history of paroxysmal nocturnal hemoglobinuria. N Engl J Med. 1995;333(19): 1253–1259. doi: 10.1056/NEJM199511093331904
- Федотова Ю.М., Костюкова Ю.И. Гирудотерапия: теория и практика // Научное обозрение. Медицинские науки. 2017. № 2. С. 22–25. [Fedotova YM, Kostyukova YI. Hirudotherapy: theory and practice. Scientific Rev Med Sci. 2017;(2):22–25. (In Russ).]
- Ефимова А.О. Фармакологические свойства экстракта Hirudo Medicinalis, мази и геля на его основе при накожном применении: Автореф. дис. ... канд. мед. наук. Москва, 2019. 17 с. [Efimova AO. Pharmacological properties of Hirudo Medicinalis extract, ointment and gel based on it for skin application [dissertation abstract]. Moscow; 2019. 17 p. (In Russ).]
- Hillmen P, Elebute M, Kelly R, et al. Long-term effect of the complement inhibitor eculizumab on kidney function in patients with paroxysmal nocturnal hemoglobinuria. Am J Hematol. 2010;85(8):553–559. doi: 10.1002/ajh.21757
- Sahin F, Akay OM, Ayer M, et al. Pesg PNH diagnosis, follow-up and treatment guidelines. Am J Blood Res. 2016;6(2):19–27.
- Parker C. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood. 2005;106(12):3699–3709. doi: 10.1182/blood-2005-04-1717