HEPATIC MANIFESTATION OF HEMOLYTIC-UREMIC SYNDROME IN AN ALLOGENEIC BONE-MARROW TRANSPLANT RECIPIENT

A 33-year-old woman presented 42 days after allogeneic bone marrow tra nsplantation for acute monocytic leukemia (AML, FAB M5) with persisten t thrombocytopenia, acute renal failure and Coombs negative hemolytic anemia. In the absence of disseminated intravascular coagulation the d iagnosis of hemolytic uremic syndrome due to immunosuppression with cy closporin A was supposed. Because cessation of cyclosporin A and thera peutic infusions of fresh frozen plasma had failed, plasmaseparation t herapy was started on day 79 after bone marrow transplantation. While hemolytic anemia improved during ongoing plasmaseparations the patient developed cholestatic liver failure due to hepatic manifestation of H US. The histological lesions of liver involvement in thrombotic microa ngiopathies are discussed and a review of the literature is presented.