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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 2. Case 2. 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)13414093102134119173
White blood cell count (×10/L)
Reticulocyte (%)0.393.10
Absolute reticulocytes8.811.
Anemia workup: Iron 18 mcg/dL. Total iron binding capacity 297 mcg/dL. TSAT 6%. Ferritin 14. B12 level 320 ng/L. Folate level 7.3 mcg/L. 2–3 mcg/dL. Total iron binding capacity 192 mcg/dL. TSAT >90%. Ferritin 642. Folate level and B12 level was not repeated
DIC workupD-dimer 555 ng/mL. Fibrinogen 111 mg/dL. PT 11.6 sec. INR 1.1. aPTT 32 sec
Hemolysis workupNo schistocytes on peripheral blood smear. LDH 877 U/L. Total bilirubin 1.7 mg/dL (indirect 1.3 mg/dL). Haptoglobin < 14 mg/dL. Direct Coombs negative. G6PD normal. ANA normal. Paroxysmal nocturnal hemoglobinuria antigen normal
Infectious workupParvovirus B19 serology and PCR negative. Hepatitis A, B, C serology was negative for active infection. HSV 1 and 2 PCR negative. HIV antigen and antibody screen 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.
ANA – antinuclear antibody; DIC – disseminated intravascular coagulation; LDH – lactate dehydrogenase; HSV – herpes simplex virus; 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