A 68-year-old male patient with a history of dyslipidemia, hypothyroidism, benign prostatic hyperplasia and chronic nonspecific hepatitis, all under medical supervision.
Carcinogenic bone marrow showed normal bone marrow; fibrosis year 2001 (Hgb hemoglobin): 13.1 g/dl, MCV: 86.7, white blood cells (GB): 3,400/mm3, absolute neutrophil count
Findings compatible with intermediate-low myelodysplastic syndrome IPSS, management only with folic acid.
Erythema multiforme Erythema multiforme Erythema nodosum Stevens- Johnson syndrome (potentially life- threatening) Toxic epidermal necrolysis (potentially life- threatening)
Cytometry of bone marrow (CDF) was performed in 2011, which showed an increase in the monoid series of mature aspect and dysplastic type alterations in the other series in hydroxymyelocele, with pharmacological progression with damaged syndrome.
Given the poor response, it was decided to use azacitidine 6 cycles of 100 mg/m2/day for 5 days a month, in 2012, with the objective of achieving early decrease in levels of GB PL always with progressive decrease.
At the end of the 6th cycle, there is new evidence of progression with progressive elevation of ADR GB and then management with thalidomide 100 mg daily.
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In July 2013, the patient consulted due to headache and vomiting.
Magnetic resonance imaging revealed amyloid microangiopathy and small cortical and subcortical hemorrhagic foci.
CBC: Hgb: 9.9 g/dl GB: 20.330 x mm3 RAM91 x mm3 PLQ 36. x mm3.
She was reassessed with myelogram, showing progression of MMC to stage II (12% blasts in BM) highlighting alteration in coagulation tests: TTPK 43 sec and prothrombin time 59%.
Hematuria persisting macroscopic and coagulation tests did not correct with fresh frozen plasma supply at 24 h of control.
It was decided to complete an outpatient study given the stability of the clinical picture.
See you again in September of the same year for generalised tonic-clonic seizures.
She was hospitalized in a critical patient unit for stabilization.
Glasgow Coma Scale score 15, without neurological focus.
Computed axial tomography (CAT) of the brain without contrast shows the presence of a 9 cc volume right frontal hematoma without surgical indication.
Persistent bleeding disorders and coagulation tests were performed.
In this coagulation study, there is isolated evidence of a factor X deficiency (54%).
It is acquired during the evolution of the patient's disease, with persistent alteration of coagulation tests.
Given the baseline hemato-oncological diagnosis and hemorrhaging complications in the context of amyloid microangiopathy and thrombocytopenia refractory to treatment, conservative management was decided, only with low-dose hydroxycarbamide.
