LEUKEMIA IN ERYTHROID BLAST CRISIS AND AUTOIMMUNE HEMOLYTIC ANEMIA: A CASE REPORT
Description
Introduction: Chronic myeloid leukemia is a chronic myeloproliferative neoplasm characterized by the uncontrolled proliferation of myeloid precursors and autoimmune hemolytic anemia is an unregulated immune reaction towards the antigens themselves that are on the surface of the membrane of red blood cells. The combination of these diseases is extremely rare and even greater when chronic myeloid leukemia is in an erythroid blast crisis. Objective: To describe a case with the coexistence of chronic myeloid leukemia in erythroid blast crisis and autoimmune hemolytic anemia. Clinical case: Patient with a history of chronic myeloid leukemia who presents an erythroid blast crisis and develops autoimmune hemolytic anemia due to warm IgG antibodies. The treatment for both diseases will be administered. After a clinical improvement of the autoimmune hemolytic anemia, he maintained the erythroid blast crisis and was administered an intensive chemotherapy regimen where complications occurred and he died. Conclusions: The treatment with steroids in autoimmune hemolytic anemia in patients with chronic myeloid leukemia is effective when they are in the chronic phase of the disease, but is little responsive when they are in blast crisis, as was the case we present, and the fatal outcome in the patient was multifactorial.
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INTRODUCTION Chronic myeloid leukemia (CML) is a chronic my elo proliferativeneoplasia characterized by the uncontrolled proliferation of myeloid precursors. Patients show a reciprocal translocation between chromosomes 9 and 22 t (9,22), and the Philadelphia chromosome is formed, which produces the BCR / ABL fusion gene with high tyrosine kinase activity. It occurs in any of its three phases: chronic, accelerated, and blast crisis. (1) The aberrant activation of kinases hinders different signaling pathways, and it leads to an increase in cell proliferation, arrest of cell maturation and differentiation processes, and resistance to apoptosis, which can bring about different phases of transformation of the LMC. (2) Blast crises can be of lymphoid, myeloid, or hybrid lineage, but in about 70% of cases, the blast lineage is myeloid. The most common phenotypes correspond to the populations of granulocytes and monocytes, but it can be in any of its morphological variants and they manifest as secondary acute leukemia. (3,4)Erythroid blast crises are very rare, occurring in only 1% of cases. (4) PRESENTATION OF THE CASE Patient MRP, female, white, urban origin, 55 years old, overweight, with a family history of a mother with CML since 2013; and personal medical history of Bronchial Asthma since childhood and CML since July 2018 where it was necessary to transfuse her with 500ml of erythrocyte concentrate on debut and she was on treatment with ImatinibGlivec, (Novartis Pharma AG, Basel, Switzerland) 400 mg/day. During the first year of diagnosis of CML, the patient presented a favorable evolution, reaching in July 2019 hematological and greater cytogenetic remission, as well as negative qualitative BCR / ABL gene rearrangement studies. She continued with the same treatment behavior and in September of that same year, she went to the emergency department consultation due to shortness of breath on exertion, easy fatigue, severe mucous skin paleness, and bone pain for more than 15 days. The patient had a good general condition despite being symptomatic. The physical examination revealed hypocoloured mucous membranes with slight icterus, the presence of hematomas and edema in the lower limbs that reached up to the middle third of both legs with easy godet, sinus tachycardia, and hepatomegaly at 2 cm below the right costal margin, of firm consistency and not painful. Due to all this situation, it was decided to hospitalize her for a comprehensive health assessment. DISCUSSION AIHA is a rare cause of anemia in CML, but when it does occur, it develops after the diagnosis of CML in the chronic phase that generally responds to steroids. In a study carried out by Mohamed A Yassin et al (11) . The transformation of CML into AML is more frequent in granulocytic variants, although in some cases erythroid blast crisis has also been described, (12) but this transformation is an aggressive type of leukemia due to the frequent association with