Case 17-2026: A 74-Year-Old Man with Pancytopenia
- páginas: 2357-2368
A 74-year-old man was admitted to this hospital because of persistent pancytopenia that had resulted in multiple red-cell transfusions. Three months before the current presentation, the patient underwent heart transplantation after a prolonged admission in the cardiac intensive care unit of this hospital. He had been admitted for decompensated heart failure due to transthyretin amyloid cardiomyopathy, for which he received treatment with infusions of inotropic and diuretic agents. The preoperative course was notable for anemia, for which he received intravenous iron therapy. In addition, the patient had persistent thrombocytopenia that prompted a switch in treatment from heparin to a direct thrombin inhibitor, despite the fact that testing for antibodies against platelet factor 4 was negative. Serologic testing performed before transplantation was positive for Epstein–Barr virus (EBV) IgG, negative for cytomegalovirus (CMV) IgG, and negative for toxoplasma IgG. Serologic testing in the donor was positive for EBV IgG and CMV IgG and negative for toxoplasma IgG.