A rare cause of haemolytic anaemia: paroxysmal nocturnal haemoglobinuria in an elderly patient.

Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired haemopoietic stem cell disorder characterised clinically by chronic haemolytic anaemia with acute episodes, thrombosis and bone marrow failure. It is a rare condition, which usually occurs in younger people. Immunophenotyping and flow cytometry play a key role in diagnosing PNH. Treatment is mainly supportive. Because it is so rare, delay in diagnosis is not uncommon in patients with PNH, which has a considerable impact on patient management and prognosis. We present this case to draw attention to this rare cause of haemolytic anaemia, which should be considered in any patient, of any age, who has signs of chronic haemolysis.

A young female with a cholangiocarcinoma in the past: is pregnancy allowed?

BACKGROUND: A 28-year-old woman developed a cholangiocarcinoma after using oral contraceptives for eight years. The common bile duct and the gallbladder were removed and four hepaticojejunostomies were performed. RESULTS: Seven years after surgery no evidence of disease recurrence is detectable and the patient wants advice regarding her wish for pregnancy. CONCLUSION: The possible role of oestrogens in the development of cholangiocarcinoma makes it difficult to give an adequate advice. As in patients with breast cancer in the past, it seems reasonable to admit pregnancy in our patient, because of a disease-free interval of longer than five years.

PIP: Long-term oral contraceptive (OC) use has been implicated as a possible factor in the development of hepatocellular carcinoma and cholangiocarcinoma. Presented, in this paper, is the case of a 35-year-old Dutch woman who developed a cholangiocarcinoma at 28 years of age after 8 years of OC use. The common bile duct and gall bladder were removed and 4 hepaticojejunostomies were performed. Seven years after surgery, with no evidence of disease recurrence, this woman sought advice regarding the feasibility of pregnancy. The possible role of estrogens in cholangiocarcinomas makes this a difficult question. The only such case reported in the literature involved a woman with inoperable cholangiocarcinoma who became pregnant with no evidence that the pregnancy stimulated tumor growth. Most studies of the interactive effects of pregnancy and recurrent malignancies have involved breast cancer. Recommended, for breast cancer patients, is postponement of pregnancy until a disease-free interval of 3-5 years has been achieved. In the absence of specific guidelines for cholangiocarcinoma survivors, it seems advisable to adhere to this same principle.