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KMID : 0366219850200010143
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Korean Journal of Hematology
1985 Volume.20 No. 1 p.143 ~ p.148
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A Case of Pure Red Cell Aplasia with Simultaneous Occurrence of Hemolytic Anemia Following Administration of Diphenylhydantion After Craniotomy
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윤규석/Kyoo Seok Yoon
이웅수/장숙진/정화순/김춘원/김기홍/Woong Soo Lee/Sook Jin Jang/Wha Soon Chung/Choon Won Kim/Ki Hong Kim
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Abstract
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A 5 year old female patient was admitted to our hospital because of abdominal rain,
aneroxia, and dark-colored urine. She had taken diphenylhydantoin for 36 days after
craniotomy.
The hematologic examination revealed normocytic normochromic anemia with
hemoglobin of 6.29m/dl, hematocrit of 17.9% and a few nucleated RBC (3/100WBC) in
peripheral blood smear. Urine was brown in color and the test for hemoglobin was
positive (3+). On bone marrow aspiration and biopsy examination, pure red cell aplasia
was considered. Complete recovery of PRCA and hemoglobinuria occurred after
withdrawal of diphenylhydantoin and administration of oxymetholone and prednisolone.
Therefore, we considered that pure red cell aplasia and hemolytic anemia were induced
by diphenylhydantoin.
The mechanism of pure red cell aplasia followed by administration of
diphenylhydantion was suggeted that it exerted a toxic effect by specific inhibition of
DNA synthesis in erythroid precursors, probably at the step of deoxyribotide formation.
The simultaneous occurence of PRCA and hemolytic anemia is rare and the mechanism
for diphenylhydantion-induced PRCA and hemolytic anemia is unclear.
We reported a case of PRCA with simultaneous occurrence of hemolytic anemia
following administration of diphenylhydantoin after craniotomy with brief review of
literature.
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