Haemophagocytic Syndrome
(Case-report and Review of Literature)
Obořilová A.1, Mayer J.1, Pavlík P.2, Buliková A.3, Vorlíček J.1
1Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. J. Vorlíček, CSc. 2Centrum kardiovaskulární a transplantační chirurgie, Brno, ředitel prof. MUDr. J. Černý, CSc.3Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MUDr. M. Penka, CSc. |
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Summary:
The haemophagocytic syndrome (HPS) is clinically characterized by fever, pancytopenia and
hepatosplenomegaly. Usually it takes an acute course with a high mortality. The pathogenetic
basis is inadequate activation of the immune system - in particular Th1-lymphocytes with subsequent
overproduction of cytokines and extreme activation of macrophages with haemophagocytosis.
The activated cells infiltrate organs, cause tissue damage and clinical manifestations of the
syndrome. From the etiological aspect two forms exist: primary (familial) with autosomal recessive
inheritance and the secondary form which forms a heterogeneous sub-group, caused as a rule
by infection and/or a tumour. The prognosis seems somewhat more favourable in secondary
forms. In treatment which is essentially the same for both forms, chemotherapy combined with
immunosuppression proves useful, in more aggressive forms chemotherapy as used in the treatment
of non-Hodgkin lymphomas. The only curative method is transplantation of haematopoietic
stem cells which is also the treatment of first choice in the familial form of haemophagocytosis. In
the submitted paper the authors present a review of contemporary knowledge on this treacherous
and relatively rare entity. The haemopgagocytic syndrome should be always taken into
account in the differential diagnosis of fever with an obscure etiology. The authors assume that
the haemophagocytic syndrome is rarely considered in practice and therefore is usually inadequately
diagnosed and thus not treated in time. In the conclusion the authors describe the case-records
of a 26-year-old female patient with haemophagocytic syndrome which developed during
pregnancy.
Key words:
Haemphagocytic syndrome - Lymphohistiocytosis
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