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Year : 2023  |  Volume : 14  |  Issue : 1  |  Page : 67

Methotrexate-Related pancytopenia associated with induced dysplasia

Laboratory of Hematology, Agen-Nerac Hospital, Agen, France

Date of Submission14-Oct-2022
Date of Acceptance30-Nov-2022
Date of Web Publication17-Feb-2023

Correspondence Address:
Dr. Nicolas Athanase
Laboratoire de Biologie Médicale, Centre Hospitalier Agen-Nérac, Route de Villeneuve Sur Lot, Saint-Esprit 47923 Agen
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joah.joah_92_22

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How to cite this article:
Athanase N, Frebet E. Methotrexate-Related pancytopenia associated with induced dysplasia. J Appl Hematol 2023;14:67

How to cite this URL:
Athanase N, Frebet E. Methotrexate-Related pancytopenia associated with induced dysplasia. J Appl Hematol [serial online] 2023 [cited 2023 Sep 22];14:67. Available from: https://www.jahjournal.org/text.asp?2023/14/1/67/369850

A 63-year-old woman presented with persistent oral pain and trismus. The patient suffered from obesity, diabetes, and rhizomelic pseudo-polyarthritis treated with corticosteroids and weekly low dose of methotrexate (MTX). Laboratory results revealed a severe pancytopenia: hemoglobin, 9 g/dL; white blood count, 0.40 × 109/L; platelets, 16 × 109/L; associated with acute renal failure: glomerular filtration rate of 18 mL/min/1.73 m2. Serum folic acid was at 18.6 nmol/L. The clinical examination showed signs of sepsis and mucositis; patient was transferred to the intensive care unit. A bone marrow aspirate showed a poor smear with granular hypoplasia associated with major signs of erythroid dysplasia ([Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, May-Grünwald Giemsa Staining, original magnification ×1000). No sign of hemophagocytic syndrome was observed and karyotype analysis was normal. The diagnosis of a MTX-related pancytopenia with induced dysplasia was retained. Folic acid rescue and granulocyte-colony-stimulating-factor therapy were initiated. At day 3 of the last injection, MTX level was still detectable at 0.08 μmol/L. In less than a week, biological analysis was strictly normal.
Figure 1: (a-f) Erythroblast with major signs of dysplasia, using, May-Grünwald Giemsa Staining, original magnification x1000.

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Even though low-dose MTX is usually well tolerated, mild-to-severe adverse effects have been described. MTX-related pancytopenia is a rare side effect and its early detection is a challenging task. It can occur at any point during therapy and is generally independent of the dose.


Nicolas Athanase wrote the manuscript, analyzed and collected data.

Elise Frébet collected, analyzed data and reviewed manuscript

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Conflicts of interest

There are no conflicts of interest.


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