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14 November 2023: Articles

Immune Checkpoint Inhibitor-Induced Pure Red Cell Aplasia: A Review of 2 Cases in Metastatic Melanoma

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy, Clinical situation which can not be reproduced for ethical reasons

Libardo Rueda Prada A* , Tatjana Gavrancic A , Miguel O. Cadena Sanabria D , Igor Dumic C , Kirk Bourgeois B , Rebecca L. King B , Yiyi Yan D

DOI: 10.12659/AJCR.941789

Am J Case Rep 2023; 24:e941789

Table 1. Case 1. Summary of laboratory workup and timeline of hospital interventions.

Time of presentationFirst 24 hDay 1Day 2Day 3Day 41 month
Hemoglobin (g/dL)
Platelet count (×10/L)277270223222188235240
White blood cell count (×10/L)
Reticulocyte (%)0.320.810.360.310.256.38
Absolute reticulocytes9.531.814.412.79.3208.6
Additional anemia workupIron 85 mcg/dL. Total iron binding capacity 188 mcg/dL. TSAT 45%. Ferritin 2307 mcg/L. B12 level >1400 ng/L. Folate level 10.0 mcg/L. Fecal occult blood test negative. Normal peripheral blood flow cytometric immunophenotyping. Parvovirus B19 serology and PCR negative
DIC workupD-dimer 2619 ng/mL. Fibrinogen 349 mg/dL. PT 13.9 sec. INR 1.3. aPTT 29 sec
Hemolysis workupNo schistocytes seen in peripheral blood smear. LDH 794 U/L (chronically elevated 624–781 U/L over last year). Total bilirubin 0.6 mg/dL. Haptoglobin < 14 mg/dL. Direct Coombs negative
Reference ranges: Reticulocyte (%) 0.60–2.71. Absolute reticulocyte 30.4–110.9×10/L. Iron 35–145 mcg/dL. Total iron binding capacity 250–400 mcg/dL. TSAT 14–50%. Ferritin 11–307 mcg/L. B12 level 180–914 ng/L. Folate level ≥4.0 mcg/L. D-dimer ≤500 ng/mL. Fibrinogen 200–393 mg/dL. PT 9.4–12.5 sec. INR 0.9–1.1. aPTT 25–37 sec. LDH 122–222 U/L. Total bilirubin ≤1.2 mg/dL. Haptoglobin 30–200 mg/dL.
DIC – disseminated intravascular coagulation; LDH – lactate dehydrogenase; PRBC – packed red blood cells; PT – prothrombin time; aPTT – activated partial thromboplastin time; TSAT – transferrin saturation.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923