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Intra-abdominal, angiofollicular lymph node hyperplasia (plasma-cell variant) with an antierythropoietic factor
Mayo Clinic Proceedings
|September 1, 1975
Summary
A rare lymph node disorder caused refractory anemia in a child. Surgical removal of the mass cured the anemia and improved growth, suggesting a secreted erythropoiesis inhibitor.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Refractory anemia in children can have complex etiologies.
- Growth retardation and hypergammaglobulinemia are concerning comorbidities.
- Standard treatments for anemia were ineffective in this case.
Observation:
- An 11-year-old girl presented with refractory hypochromic microcytic anemia, hypoferremia, and growth retardation.
- Ferrokinetic studies showed impaired iron incorporation into red blood cells.
- A plasma-cell variant of angiofollicular hyperplasia was identified in a resected nodal mass.
Findings:
- Surgical removal of the lymph node mass led to complete anemia correction and improved growth.
- Preoperative serum inhibited erythropoiesis in an exhypoxic mouse model.
- The inhibitory effect on erythropoiesis resolved post-surgery, implicating the lymph node.
Implications:
- This case suggests a novel mechanism of anemia associated with angiofollicular hyperplasia.
- A secreted factor from the hyperplastic lymph node likely suppressed erythropoiesis.
- Successful surgical intervention highlights the importance of identifying and removing the causative lesion.