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Aplastic anemia associated with Crohn's disease: a tertiary center retrospective study
Song Su1, ZhenZhen Liu1, Fang Wang2
1State key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, 710032, China.
Insights
Aplastic anemia (AA) rarely co-occurs with Crohn's disease (CD), primarily affecting males. This rare condition presents with severe symptoms and poor prognosis, often unresponsive to conventional therapies.
Area of Science:
- Gastroenterology
- Hematology
- Immunology
Background:
- Aplastic anemia (AA) is infrequently associated with inflammatory bowel disease (IBD), predominantly ulcerative colitis (UC).
- Limited data exists on the association between aplastic anemia and Crohn's disease (CD).
Observation:
- A study reviewed 657 patients with CD, identifying six cases of concurrent aplastic anemia (AA-CD).
- The incidence of AA-CD was 0.91% in this cohort.
- Patients were predominantly male, with average diagnoses at ages 41.5 for CD and 39.2 for AA.
Findings:
- Common symptoms included abdominal pain and hyperpyrexia.
- Endoscopic findings revealed severe, discontinuous inflammation and deformed ileocecal valves.
- Conventional pharmacotherapy showed limited efficacy, with four of six patients succumbing to CD complications.
Implications:
- The concurrence of AA and CD suggests a potential role for immunologic impairment in pathogenesis.
- AA-CD appears to be a severe condition with a poor prognosis, particularly in males.
- Allogeneic stem cell transplantation may offer a more effective therapeutic option than conventional treatments.
Abstract:
Aplastic anemia (AA) has been reported to be associated with inflammatory bowel disease (IBD), but mostly with ulcerative colitis (UC). Little is known about the associations between AA and Crohn's disease (CD). We aim to determine the portraits of patients with AA-CD. Among a total of 657 patients with CD registered in Xijing Hospital of Digestive Diseases IBD center from January 2008 to October 2018, the patients diagnosed with concurrent AA were reviewed. Clinical presentation, medical history, endoscopic features, response to treatment, and prognosis in this set of patients were collected. Six male patients confirmed as CD associated with AA were identified. The incidence rate was 0.91% for CD associated with AA in our series. Average age at diagnosis of CD and AA was 41.5 and 39.2 years old, respectively. Abdominal pain and hyperpyrexia were the most common symptoms. Endoscopic findings showed discontinued severe inflammation, and all these patients presented with deformed ileocecal valve. Conventional pharmacotherapy failed to achieve a favorable effect. Four of six patients died from CD progression and its complications. None of these patients received bone marrow transplantation treatment because of poverty. Concurrence of AA and CD is a relatively rare condition. Immunologic impairment may play an important pathogenic role and deserves further attention. Males are more susceptible to this condition. Patients with AA-CD are prone to a severe clinical course and poor prognosis. Conventional therapy achieves no potent effect, and allogeneic stem cell transplantation may be a potentially efficient therapy.