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Diagnostic Utility of Complement Immunohistochemical Studies in Post–Stem Cell Transplant Intestinal Thrombotic Microangiopathy: Case Report
- Source :
- Journal of Pediatric Hematology/Oncology. 39:282-286
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Thrombotic complications are a significant source of morbidity and mortality following hematopoietic stem cell transplants. Among them, transplant-associated thrombotic microangiopathy (TA-TMA) is a well-recognized syndrome that can affect various organ systems. Its etiology is related to endothelial injury accompanied by complement activation. As many of the signs and symptoms of the disease are also encountered in other complications following hematopoietic stem cell transplant, it can often be difficult to establish the diagnosis based on clinical data alone. Histopathologic examination of various tissues may be performed in difficult cases. However, the microscopic features of TA-TMA also overlap with those seen in other posttransplant complications, suggesting a need for additional tests to help in diagnosis. Here we describe a patient who presented with hemolytic anemia, thrombocytopenia, renal and neurological impairment, who also developed significant bloody diarrhea. Flexible sigmoidoscopy with biopsies was performed to determine the exact etiology of his gastrointestinal bleed. A diagnosis of intestinal TA-TMA was established with the use of immunohistochemical stains for complement components C5b-9 and C4d. This is the first report that highlights the utility of complement staining on histologic sections from digestive samples to render a definitive diagnosis of intestinal TA-TMA.
- Subjects :
- Male
Hemolytic anemia
Pathology
medicine.medical_specialty
Thrombotic microangiopathy
Hepatic veno-occlusive disease
Complement C5b
Disease
03 medical and health sciences
0302 clinical medicine
Complement C4b
medicine
Humans
Child
medicine.diagnostic_test
Thrombotic Microangiopathies
business.industry
Sigmoidoscopy
Hematology
medicine.disease
Immunohistochemistry
Peptide Fragments
Intestinal Diseases
Graft-versus-host disease
Oncology
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Etiology
Stem cell
Gastrointestinal Hemorrhage
business
Stem Cell Transplantation
030215 immunology
Subjects
Details
- ISSN :
- 10774114
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Hematology/Oncology
- Accession number :
- edsair.doi.dedup.....30afd19cf71f159058263aa9079ecdde
- Full Text :
- https://doi.org/10.1097/mph.0000000000000729