Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency

다국어 초록 (Multilingual Abstract)

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.

참고문헌 (Reference)

1 Justo D, "Thrombosis associated with acute cytomegalovirus infection: a meta-analysis" 22 : 195-199, 2011

2 Fiehn C, "Superficial migratory thrombophlebitis in a patient with reversible protein C deficiency and anticardiolipin antibodies" 53 : 843-844, 1994

3 Antopolsky M, "Splenic infarction: 10 years of experience" 27 : 262-265, 2009

4 Breuer C, "Splenic infarction in a patient hereditary spherocytosis, protein C deficiency and acute infectious mononucleosis" 167 : 1449-1452, 2008

5 van Hal S, "Splenic infarction due to transient antiphospholipid antibodies induced by acute Epstein- Barr virus infection" 32 : 245-247, 2005

6 Suzuki Y, "Splenic infarction after Epstein-Barr virus infection in a patient with hereditary spherocytosis" 85 : 380-383, 2007

7 Eichner ER, "Splenic function: normal, too much and too little" 66 : 311-320, 1979

8 Troy K, "Protein C and S levels in acute leukemia" 37 : 159-162, 1991

9 Khor B, "Laboratory tests for protein C deficiency" 85 : 440-442, 2010

10 Ghanayem BI, "Hemolytic anemia, thrombosis, and infarction in male and female F344 rats following gavage exposure to 2-butoxyethanol" 53 : 97-105, 2001

11 Olson JF, "Functional deficiency of protein C associated with mesenteric venous thrombosis and splenic infarction" 13 : 168-171, 1991

12 Naithani R, "Autoimmune hemolytic anemia in India: clinico- hematological spectrum of 79 cases" 11 : 73-76, 2006

13 Horeau J, "An unusual complication of acquired hemolytic anemia, splenic infarction" 85 : 663-666, 1963

14 Farah RA, "Acquired protein C deficiency in a child with acute myelogenous leukemia, splenic, renal, and intestinal infarction" 22 : 140-143, 2011

15 Tzanck A, "Acquired hemolytic anemia with infarct of the spleen; splenectomy; recovery" 67 : 286-290, 1951