Allopurinol により汎血球減少を来した骨髄増殖性疾患 Allopurinol Induced Pancytopenia in a Patient with Myeloproliferative Disorder

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症例は61歳男性。慢性糸球体腎炎の既往あり。1993年3月より,高尿酸血症に対しallopurinol (AL)を内服していた。同年5月,血小板増多のため本院第1回入院。WBC 10,100/μ<i>l</i>(未熟好中球+, 赤芽球+),Hb 12.7 g/d<i>l</i>, Plt 971×10<sup>3</sup>/μ<i>l</i>, 末梢血染色体正常。骨髄では著明な線維化を認め,骨髄線維症が疑われた。2カ月後,汎血球減少のため第2回入院。WBC 1,300/μ<i>l</i>, Hb 6.2 g/d<i>l</i>, Plt 10×10<sup>3</sup>/μ<i>l</i>, 骨髄は著明な低形成であった。ALによる汎血球減少と考え同剤を中止後,granulocyte-colony stimulating factor (G-CSF), erythropoietin (EPO), oxymetholoneの投与にて,約1カ月半後,3血球系の回復を認めた。回復後の骨髄細胞を汎血球減少時の血清とoxipurinol (OL)の存在下で培養すると,CFU-G, E, Megの著明な抑制が認められた。ALによる汎血球減少は稀で,致死的な報告もみられる。本例はサイトカイン併用療法で比較的短期間に造血の改善をみた。

We reported a rare case of pancytopenia caused by allopurinol. A 61-year-old man was first admitted in May 1993, because of thrombocytosis. He had suffered from chronic glomerulonephritis. He was administered allopurinol for hyperuricemia from March 1993. On first admission the laboratory findings revealed leukocytosis (10,100/μ<i>l</i>) and thrombocytosis (971×10<sup>3</sup>/μ<i>l</i>) in the peripheral blood. Myelofibrosis was strongly suspected due to increased number of MgK and reticular fiber in the bone marrow. Two months later, he readmitted due to pancytopenia (WBC 1,300/μ<i>l</i>, Hb 6.2 g/d<i>l</i>, Plt 10×10<sup>3</sup>/μ<i>l</i>). His bone marrow showed markedly hypocellular. Because we suspected that pancytopenia was induced by allopurinol, we discontinued allopurinol and administered oxymetholone, G-CSF, and EPO. WBC, RBC, and platelet count had been recovered about one and half months later. In vitro co-culture indicated that CFU-G, E, and Meg in the bone marrow cells after recovery from pancytopenia were markedly suppressed in the presence of patient's serum and oxipurinol. Pancytopenia due to allopurinol was reported to be rare, and some authors showed that it will sometimes be fatal. Because pancytopenia of this case had been recovered in a relatively short time with cytokine therapy, it was thought to be effective for pancytopenia due to drug like this case.

収録刊行物

  • 臨床血液 = The Japanese Journal of Clinical Hematology

    臨床血液 = The Japanese Journal of Clinical Hematology 38(1), 64-71, 1997-01-30

    一般社団法人 日本血液学会

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各種コード

  • NII論文ID(NAID)
    10013847865
  • NII書誌ID(NCID)
    AN00252940
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    04851439
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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