Abstract
Androgens widely used in the treatment of bone marrow failure syndromes can in rare cases cause hepatic peliosis, a pathological entity characterized by multiple blood-filled cavities in the liver parenchyma. Bone marrow failure syndromes per se are associated with a low coagulation status, which is further magnified by bone marrow transplantation for aplastic anaemia due to deep thrombocytopenia. Both these conditions can cause bleeding; their combination is especially dangerous. We describe two cases of aplastic anaemia due to paroxysmal nocturnal hemoglobinuria and Fanconi syndrome, in which patients developed peliosis hepatis after prolonged treatment with androgens. One patient developed severe subcapsular bleeding, successfully treated with catheterization of the right hepatic artery and embolization of the bleeding site. The second patient bridged over deep post-transplant aplasia with high frequency platelet transfusions, and demonstrated an uncomplicated post-BMT course. We suggest avoiding or interrupting treatment with androgens in patients preparing for BMT.Androgen-steroids have been commonly used in the past for treating patients with bone marrow failure syndromes.1 Development of more effective treatment modalities such as growth factors, immunosuppressive agents, and stem cell transplantation has largely displaced androgens from the therapeutic armamentarium.
Patients receiving prolonged treatment with androgens face an increased risk of developing hepatic tumours, most of which appear to be benign-such as adenomas and peliosis. Such benign hepatic tumours are usually androgen-dependent, and generally decrease in size after cessation of treatment.2,3 Peliosis is a pathological entity characterized by multiple blood-filled cavities, mostly involving the liver (peliosis hepatis). Peliosis hepatis is uncommon; however, it is one of the most serious complications associated with the use of androgen-steroids.4,5
In the present article, we report our experience involving 2 patients with bone marrow failure syndromes (Fanconi Anaemia and paroxysmal nocturnal hemoglobinuria) who developed peliosis hepatis following androgen-steroid treatment.
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