Decrease in PNH-type Blood Cells after the Cessation of Thrombopoietin Receptor Agonist in a Case of AA-PNH Syndrome.

Intern MedMar 17, 2026 (epub)
Case ReportHematology

Satoshi Ichikawa, Shunsuke Hatta, Noriko Fukuhara et al.

✦ AI-curated · Sources linked

Case in brief

A 64-year-old man with severe aplastic anemia had a partial response to immunosuppressive therapy, followed by sustained cytopenia recovery with a thrombopoietin receptor agonist (TPO-RA). Over subsequent years, serum lactate dehydrogenase gradually rose, and testing showed marked expansion of paroxysmal nocturnal hemoglobinuria (PNH) clones. After a transient hemolytic episode associated with SARS-CoV-2 infection, TPO-RA was stopped. Follow-up showed fewer PNH clones. Blood counts declined moderately but remained stable without transfusion support.

What made this case unusual

PNH clones decreased after TPO-RA withdrawal, despite the preceding marked expansion during treatment; the patient’s blood counts remained stable without transfusions.

Diagnostic / clinical pearl

In a patient with aplastic anemia receiving TPO-RA, rising lactate dehydrogenase and expanding PNH clones may warrant attention to clonal evolution and hemolysis; this case also documents clone reduction after treatment cessation.

Source

PubMed · PMID 41850841

Published in Intern Med. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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