Allogeneic peripheral blood stem cell transplantation complicated with megaloblastic anemia: two cases report and literatures review / 中华器官移植杂志

ABSTRACT

Objective Combined with the medical records of two patients with megaloblastic anemia (MA) after allogeneic hematopoietic stem cell transplantation (AHSCT),the relevant literature was reviewed.Methods The medical records of two patients with MA after AHSCT were analyzed retrospectively.The primary disease was diagnosed by analyzing the blood cells,bone marrow cell morphology,cell chemical dyeing,bone marrow biopsy and immune classification.After AHSCT,MA was diagnosed through bone marrow cell morphology,folic acid and vitamin B12 detection.Results AT 32nd day after transplantation,bone marrow cells morphological examination of case 1 showednucleated cells proliferation activity,granulocytes proliferation activity,giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity,higher proportion of immature red blood cells,most of whose nucleus developed later than the cytoplasm;megakaryocytes and platelets scattered distribution.Blood contents of folic acid and VB12 were far below the reference range.After administration of folic acid and VB12 for 2 weeks,routine blood test showed the volume of red blood cells returned to normal.Reexamination of bone marrow cell morphology showed megaloblastic cells disappeared.Three months after transplantation,bone marrow cells morphological examination in case 2 showednucleated cells proliferation activity,low granulocytes proliferation,giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity,higher proportion of orthochrmatic normoblasts,most of whose nucleus developed later than the cytoplasm;scattered distribution of megakaryocytes and platelets.Blood contents of folic acid were far below the reference range,but the content of VB12 was normal.After administration of folic acid and VB12 for 2 weeks,the routine blood test showed the volume of red blood cells returned to normal.The reexamination of bone marrow cell morphology showed megaloblastic cells disappeared.Conclusion After AHSCT,attention should be paid to the detection of folic acid and VB12 in vivo.Folic acid and VB12 are timely supplemented when necessary to avoid the occurrence of MA in patients with AHSCT.