Journal of Yeungnam Medical Science

Original article

Dentistry
Effect of nonsurgical periodontal therapy and smoking status on hematological variables related to anemia of chronic disease in chronic periodontitis patient: a case-control study: Sangita Show, Somen Bagchi, Arka Kanti Dey, Ramanarayana Boyapati, Pritish Chandra Pal, Kanikanti Siva Tejaswi; J Yeungnam Med Sci. 2022;39(3):244-249. Published online May 16, 2022; DOI: https://doi.org/10.12701/jyms.2022.00045

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Abstract PDF: Background
Chronic infectious, inflammatory, or neoplastic disorders are associated with anemia of chronic disease. Chronic inflammatory diseases such as periodontitis may contribute to masked anemia, especially in smokers. This study was aimed at verifying and comparing the efficacy of nonsurgical periodontal therapy (NSPT) for improving anemia among chronic periodontitis patients with and without the habit of smoking.
Methods
Thirty systemically healthy individuals with chronic periodontitis were divided into two groups of 15 each, smokers (group A) and nonsmokers (group B). The groups were compared based on hematological parameters such as serum erythropoietin (SE) and serum ferritin (SF) levels at baseline and 3 months after NSPT for anemia evaluation.
Results
The baseline SE levels in groups A and B were 11.84 and 15.19 mIU/mL (p=0.031), respectively; the corresponding levels at 3 months after NSPT were 13.00 and 17.74 mIU/mL (p=0.022). The baseline SF levels in groups A and B were 95.49 and 44.86 ng/mL (p=0.018), respectively; the corresponding levels at 3 months after NSPT were 77.06 and 39.05 ng/mL (p=0.009). Group B showed a significant increase and decrease in the SE and SF levels, respectively, at 3 months after NSPT (p=0.035 and p=0.039, respectively), whereas group A showed insignificant changes (p=0.253 and p=0.618, respectively).
Conclusion
NSPT led to an improvement in anemia among chronic periodontitis patients. However, the improvement is less in smokers compared to that in nonsmokers. Furthermore, SF and SE levels might serve as effective biomarkers for assessing anemia in smokers and nonsmokers with chronic periodontitis.

Case reports

Obstetrics, Gynecology, and Reproductive Medicine
Posterior reversible encephalopathy syndrome related to anemia correction in a patient with uterine myoma: a case report: Jisun Lee, Hyun Jung Lee; J Yeungnam Med Sci. 2022;39(4):336-340. Published online September 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.01375

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Although posterior reversible encephalopathy syndrome (PRES) is induced by various causes, a few cases have occurred after severe anemia correction. In this case report, a 45-year-old female patient visited emergency department with a chief complaint of dizziness due to severe anemia related to hypermenorrhea caused by uterine myoma. Before her operation, she had an abrupt headache and seizure during anemia correction with transfusion and injection of gonadotropin-releasing hormone agonist. Immediately after the operation, she experienced visual disturbances, followed by limb weakness and tonic-clonic movements. Magnetic resonance imaging showed alterations in parietal and occipital lobes suggesting cerebrovascular edema with hypoperfusion. Here, we presented and discussed the clinical and radiologic features of PRES related to anemia correction.

Citations

Citations to this article as recorded by

Posterior reversible encephalopathy syndrome following blood transfusion and GnRH agonist
Sanjai Subha, Donal Skelly, Damian Jenkins
Practical Neurology.2026; : pn-2025-004949. CrossRef
Posterior Reversible Encephalopathy Syndrome (PRES) following blood transfusion in a polytrauma victim, an atypical occurrence
Erum Shariff, Nehad Mahmoud Soltan
Turkish Journal of Emergency Medicine.2024; 24(3): 180. CrossRef
Fatal posterior reversible encephalopathy syndrome after blood transfusion in a patient with myelodysplastic syndromes
Ken Takigawa, Takahiro Shima, Chiaki Kubara, Shun Akamine, Sae Utsumi, Teruhiko Yoshino, Mariko Minami, Masayasu Hayashi, Yayoi Matsuo, Takuro Kuriyama, Reiko Yoneda, Shuichi Taniguchi, Tetsuya Eto
Transfusion.2024; 64(9): 1791. CrossRef

Obstetrics, Gynecology, and Reproductive Medicine
Twin anemia polycythemia sequence in a dichorionic diamniotic pregnancy: a case report: Soo-Young Lee, Jin Young Bae, Seong Yeon Hong; J Yeungnam Med Sci. 2022;39(2):150-152. Published online July 2, 2021; DOI: https://doi.org/10.12701/yujm.2021.01060

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Abstract PDF

Complications related to the vascular anastomosis of the placental vessels in monochorionic twins are fatal. The clinical syndromes of feto-fetal transfusion include twin anemia polycythemia sequence (TAPS), twin-twin transfusion syndrome, and twin reversed arterial perfusion sequence. We present an extremely rare case of TAPS in a dichorionic diamniotic pregnancy. A 36-year-old woman, gravida 0, para 0, was referred to our hospital with suspected preterm premature membrane rupture. Although her pelvic examination did not reveal specific findings, the non-stress test result showed minimal variability in the first fetus and late deceleration in the second one. An emergency cesarean section was performed. The placenta was fused, and one portion of the placenta was pale, while the other portion was dark red. The hemoglobin level of the first fetus was 7.8 g/dL and that of the second one was 22.2 g/dL.

Citations

Citations to this article as recorded by

Twin Anemia-Polycythemia Sequence (TAPS) bei dichorialer Geminigravidität
Kathrin Haßdenteufel, Tina Heinzmann, Kristina Killinger, Julia Spratte, Christoph Berg, Ingo Gottschalk, Hans-Peter Sinn, Michael Elsässer, Alexandra von Au
Geburtshilfe und Frauenheilkunde.2025; 85(05): 487. CrossRef
Unusual Twin Anemia-polycythemia Sequence in a Dichorionic Diamniotic Pregnancy. A Case Report and Systematic Review

Journal of Medical Clinical Case Reports.2025;[Epub] CrossRef
Twin Anemia-Polycythemia Sequence With Spontaneous Resolution in Dichorionic Diamniotic Twin Pregnancy: A Case Report and a Review of the Literature
Yoshihiro Yoshimura, Katsusuke Ozawa, HIroyuki Goto, Yu Yamazaki, Hitoshi Isohata, Daigo Ochiai
Cureus.2024;[Epub] CrossRef
Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report
Tania Jeyaseelan, Panicos Shangaris, Athina Efthymiou, Linzi Martin, Lisa Story, Surabhi Nanda, Neelam Gupta, Mudher Al-Adnani, Andreas Marnerides, Kypros H. Nicolaides, Srividhya Sankaran
Journal of Medical Case Reports.2023;[Epub] CrossRef

Hematology
Pembrolizumab-related autoimmune hemolytic anemia in a patient with metastatic lung adenocarcinoma: a case report: Dong Won Baek, Yee Soo Chae; Yeungnam Univ J Med. 2021;38(4):366-370. Published online March 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.00899

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Abstract PDF

Immune checkpoint inhibitors (ICIs) have become the main drugs for programmed cell death receptor-1 or ligand-1 expressing non-small cell lung cancer (NSCLC) combined with conventional chemotherapy. ICIs are generally more tolerable than cytotoxic chemotherapies in terms of toxicity, and ICI-related adverse events are mild and manageable. However, these drugs may lead to unexpected severe adverse events such as immune-related hematologic toxicities, which could be life-threatening. Here, a rare case of a pembrolizumab-related adverse event in a patient with NSCLC who showed early-onset hemolytic anemia and recovered by high-dose steroid and a series of plasma exchanges is reported.

Citations

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Immunotherapy-associated autoimmune hemolytic anemia induced by anti-PD-1 therapy in esophageal cancer: A case report and literature review
Zijian Qiu, Mixue Sun, Chunyan Dai, Xiaoping Zhu
Medicine.2025; 104(15): e42174. CrossRef
Severe immunotherapy-related autoimmune hemolytic anemia induced by toripalimab in a patient with deficient mismatch repair colorectal cancer: a case report and literature review
Xu Ma, Jin-Sheng Ye, Zhi Liu, Quan-Li Geng
Frontiers in Medicine.2025;[Epub] CrossRef
Case Report: Life-threatening pancytopenia with tislelizumab followed by cerebral infarction in a patient with lung adenocarcinoma
Hang-Yu Gu, Jing-Wen Zhao, Yin-Shuang Wang, Zhuo-Nan Meng, Xiu-Ming Zhu, Fu-Wei Wang, Ai-Hong Zheng, Guo-Qing Wu
Frontiers in Immunology.2023;[Epub] CrossRef
Immunotherapy-associated Autoimmune Hemolytic Anemia
Steven R. Hwang, Antoine N. Saliba, Alexandra P. Wolanskyj-Spinner
Hematology/Oncology Clinics of North America.2022; 36(2): 365. CrossRef
Therapeutic plasma exchange in the management of immune checkpoint inhibitor‐associated immune‐related adverse effects: A review
Oluwatoyosi A. Onwuemene, Chizoba I. Nnoruka, Christopher J. Patriquin, Laura S. Connelly‐Smith
Transfusion.2022; 62(11): 2370. CrossRef
Diagnosis and management of cold agglutinin disease associated with low-grade B-cell lymphoma in a patient receiving pembrolizumab for lung cancer
Nabin Raj Karki, Peyton McElhone, Natasha Savage, Nagla Abdel Karim
BMJ Case Reports.2021; 14(8): e243751. CrossRef
Red Blood Cell Autoantibodies in Patients Treated with Immune Checkpoint Inhibitors
Eungjun Yoon, Tae Yeul Kim, Sun Kyoung Mun, Duck Cho
The Korean Journal of Blood Transfusion.2021; 32(3): 201. CrossRef

Pediatrics, Perinatology, and Child Health
Successful engraftment after infusion of multiple low doses of CD34+ cells from a poorly matched sibling donor in a patient with severe aplastic anemia: Chang Dae Kum, Mi Jin Lee, Jun Eun Park; Yeungnam Univ J Med. 2019;36(2):148-151. Published online December 21, 2018; DOI: https://doi.org/10.12701/yujm.2019.00038

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Abstract PDF

The dose of CD34+ cells is known to influence the outcome of allogeneic peripheral blood stem cell (PBSC) and/or T-cell-depleted transplantation. A previous study proposed that 2×10⁶ CD34+ cells/kg is the ideal minimum dose for allogeneic transplantation, although lower doses did not preclude successful therapy. In the case we present here, CD34+ cells were collected from a matched sibling donor on the day of allogeneic hematopoietic stem cell transplantation; however, the number of cells was not sufficient for transplantation. Consequently, PBSCs were collected three additional times and were infused along with cord blood cells from the donor that were cryopreserved at birth. The cumulative dose of total nuclear cells and CD34+ cells was 15.9×10⁸ cells/kg and 0.95×10⁶ cells/kg, respectively. White blood cells from this patient were engrafted on day 12. In summary, we report successful engraftment after infusion of multiple low doses of CD34+ cells in a patient with severe aplastic anemia.

Citations

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Body Surface Area-Based Dosing of Mycophenolate Mofetil in Pediatric Hematopoietic Stem Cell Transplant Recipients: A Prospective Population Pharmacokinetic Study
Hyun Jin Park, Kyung Taek Hong, Nayoung Han, In-Wha Kim, Jung Mi Oh, Hyoung Jin Kang
Pharmaceutics.2023; 15(12): 2741. CrossRef

Case Reports

Hematology
Ceftizoxime-induced immune hemolytic anemia associated with multi-organ failure: Jin Young Huh, Ari Ahn, Hyungsuk Kim, Seog Woon Kwon, Sujong An, Jae Yong Lee, Byoung Soo Kwon, Eun Hye Oh, Do Hyun Park, Jin Won Huh; Yeungnam Univ J Med. 2017;34(1):123-127. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.123

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Abstract PDF

Drug-induced immune hemolytic anemia (DIIHA) is a rare side effect of drugs. DIIHA may cause a systemic inflammatory response that results in acute multi-organ failure and death. Ceftizoxime belongs to the class of third generation cephalosporins, which are the most common drugs associated with DIIHA. Herein, we present a case of a 66-year-old man who developed fatal DIIHA after receiving a second dose of ceftizoxime. He was admitted to receive photodynamic therapy. He had a history of a single parenteral dose of ceftizoxime 3 months prior to admission. On the day of the procedure — shortly after the infusion of ceftizoxime — the patient's mental status was altered. The blood test results revealed hemolysis. Oliguric acute kidney injury developed, and continuous renal replacement therapy had to be applied. On the suspicion of DIIHA, the patient underwent plasmapheresis. Diagnosis was confirmed by a detection of drug-dependent antibody with immune complex formation. Although his hemolysis improved, his liver failure did not improve. He was eventually discharged to palliative care, and subsequently died.

Citations

Citations to this article as recorded by

Case report: Decreased hemoglobin and multiple organ failure caused by ceftizoxime-induced immune hemolytic anemia in a Chinese patient with malignant rectal cancer
Can Lou, Meng Liu, Ting Ma, Liu Yang, Dan Long, Jiaming Li, Hang Lei, Dong Xiang, Xuefeng Wang, Lei Li, Xiaohong Cai
Frontiers in Immunology.2024;[Epub] CrossRef
Laboratory Workup of Drug-Induced Immune Hemolytic Anemia
Hyunjin Nah, Hyun Ok Kim
The Korean Journal of Blood Transfusion.2018; 29(1): 18. CrossRef

Hematology
A Case of Mercury Intoxication Associated with Pernicious Anemia.: Kyoung Ae Chang, Hyun Do Kim, Sun Jung Mun, Dong Hee Kim, Sung Ho Chun, Ha Young Lee, Dong Woon Bae, Hee Soon Cho, Kyung Hee Lee, Myung Soo Hyun; Yeungnam Univ J Med. 2006;23(1):103-107. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.103

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Abstract PDF

Pernicious anemia is the frequent cause of megaloblastic anemia, and it is the result of a vitamin B12 deficiency due to the decrease or absence of intrinsic factor (IF) because of gastric mucosa atrophy or autoimmune destruction of IF-producing parietal cells. With the existence of a severe gastric atrophy, there is a decreased in acid and IF production and a further change in vitamin B12 absorption. Mercury is ubiquitous in nature and exists in 3 forms, elemental mercury, inorganic salts and organic compounds. Organic forms, specifically methyl mercury, are the most toxic of the 3 classes of mercurials. Methyl mercury exerts its most devastating effect on the central nervous system by causing psychiatric disturbances, ataxia, visual loss, hearing loss, and neuropathy. We report a case of mercury intoxication associated with pernicious anemia. The 77 years old patient was referred to Yeungnam University Hospital for tongue pain, somatitis, headache and aggressive behavior. He had taken an unevaluated medicine for a long time. After clinical evaluation, this case was diagnosed as a pernicious anemia and the unevaluated medicine was made up of mercury. After the administration of D-penicillamine and intramuscular injection of BAL and cobalamine, clinical symptoms and aggressive behavior were improved as well as laboratory findings.

Citations

Citations to this article as recorded by

Mercury exposure leading to functional vitamin B12 deficiency and subacute combined degeneration: a case report and literature review
Isidora Semnic, Valentino Rački, Olivia Perković, Vladimira Vuletić
Frontiers in Toxicology.2025;[Epub] CrossRef

Hematology
Two Cases of Vitamin B12 Deficiency Anemia Combined with Iron Deficiency Anemia.: Eun Hae Kim, Hee Soon Cho, Chae Hoon Lee, Kyung Dong Kim, Myung Soo Hyun; Yeungnam Univ J Med. 2003;20(2):206-211. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.206

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Abstract PDF: Simultaneous deficiency of Vitamin B12 and iron induces that the bone marrow erythroid megaloblastosis and peripheral blood macroovalocytosis are masked because of countervailing the tendency of iron deficiency to produce hypochromic microcytic erythrocytes. We report two cases of Vitamin B12 deficiency anemia with low mean corpuscular volume (MCV) due to combined iron deficiency anemia with review of literature.

Original Articles

Nephrology
A Study for Improvement of Erythropoietin Responsiveness in Hemodialysis Patients.: Jong Won Park, Jun Yeung Do, Kyung Woo Yoon; Yeungnam Univ J Med. 2001;18(2):226-238. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.226

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Abstract PDF: BACKGROUND
Anemia in chronic renal failure plays an important rolr in increasing morbidity of dialysis patients. The causes of the anemia are multifactorial. With using of erythropoietin(EPO), most of uremia-induced anemia can be overcome. However, about 10% of renal failure patients shows EPO-resistant anemia. Hyporesponsiveness to EPO has been realted to many factors: iron deficiency, aluminum intoxication, inflammations, malignancies and secondary hyperparathyroidism. So I evailuated the improvement of EPO responsiveness after correction of above several factors. MATERIALS AND METHODS: Seventy-two patients on hemodialysis over 6 months were treated with intravenous ascorbic acid(IVAA, 300 mg t.i.w. for 12 weeks). After administration of IVAA for 12 weeks,patients were classified into several groups according to iron status, serum aluminum levels and i-PTH levels. Indivisualized treatments were performed; increased iron supplement for absolute iron deficiency, active vitamin D3 for secondary hyperparathyroidism and desferrioxamine(DFO, 5 mg/kg t.i.w.) for aluminum intoxication or hyperferritinemia. RESULTS: 1) Results of IVAA therapy for 12 weeks on all patients(n=72) Hemoglobin levels at 2,4,6 week were significantly elevated compared to baseline. but those of hemoglobin at 8, 10, 12 week were not significantly different. 2) Result of IVAA therapy for 20 weeks on patients with 100 microgram/1< or =ferritin<500 microgram/1 and transferrin saturation(Tsat) below 30%(n=30) After treatment of IVAA for 12 weeks, patients were evaluated the response of therapy according to iron status. Patient with 100 microgram/1< or =ferritin?500 microgram/1 and Tsat below 30% showed the most effective response. These patients were treated further for 8 weeks. Hemoglobin levels at 2, 4 week were significantly increased compared to baseline with significantly reduced doses of EPO at 2, 4, 10, 12, 16, 20 week. Concomitantly significantly improvement of Tsat at 2, 6, 16, 20 week compared to baseline were identified. 3) Result of IVAA therapy for 12 weeks followed by DFO therapy for 8 weeks on patients with serume aluminum above 4 microgram/1(n=12) Hemoglobin levels were not significantly increased during IVAA therapy for 12 weeks but dosages of EPO were significantly decreased at 2, 4, 6, 8 week during DFO therapy compared to pre-treatment status. CONCLUSION: IVAA can be helpful for the treatment of the anemia caused by functional iron deficiency and can reduce the dosage of EPO for anemia correction. And administration of low dose DFO, in cases of increased serum aluminum level, can reduce the requirment of EPO.

Nephrology
Long-term Effect of Desferrioxamine to rHuEPO Regident Anemia in Hemodialysis Patients.: Sang Woo Lim, Hang Jae Jung, Sung Wha Bae, Jun Young Do, Kyung Woo Yoon; Yeungnam Univ J Med. 1997;14(2):399-414. Published online December 31, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.2.399

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Abstract PDF: There are several factors concerning to anemia in chronic renal failure patients. But when rHuEPO is used, most of these factors can be overcome, and the levels of hemoglobin are increased, However, about 10% of the renal failure patients represent rHuEPO-resistant anemia eventhough high dosage of rHuEPO. For these cases, desferrioxamine can be applied to correct rHuEPO resistnacy, and many mechanism og DFO are arguing. So we are going to know whether DFO can applied to correct anemia of the such patients, how long its effect can continued. The seven patients as experimental group(DFO+EPO) who represent refractoriness to rHuEPO and the other seven patients as control group(EPO) were included. Experimental group has lower than 9 g/dL of hemoglobin levels despite high rHuEPO dosage (more than 4000U/Wk) and showed normochromic anemia. There were no definitive causes of anemia such as hemorrhage or iron deficiency. Control group patients has similar characteristics in age, mean dialysis duration but showed adequate response to rHuEPO. DFO was administered to experimental group for 8 weeks along with rHuEPO(the rHuEPO individual mean dosage had been determined by mean dosage of the previous 6 months. Total mean dosage; 123.5 U/Kg/Wk). After 8 weeks of DFO administration, the hemoglobin and rHuEPO dosage levels were checked for 15 consecutive months. It should be noted that the patients determined their own rHuEPO dosage levels according to hemoglobin levels and economic status. In control group, rHuEPO was administered by the same method used in experimental group without DFO through the same period. Fifteen months of ovservation period after DFO trial were divided as Time I(7 months after DFO trial) and Times II(8 months after Time I). The results are as follows: Before DFO trial, mean hemoglobin level of experimental group was 7.8 g/dL, which is similar level(p>0.05) to control group(mean Hb; 8.2 g/dL). But in experimental group, significantly(p<0.05) higher dosages of rHuEPO(mean; 123.5 U/Kg/Wk) than control group (mean;41.6 U/Kg/Wk) had been used. It means resistancy to rHuEPO of experimental group. But after DFO trial, the hemoglobin levels of the experimental group were increased significantly(p<0.05), and these effect were continued to II.(Time I; mean 8.6g/dL, Time II; mean 8.6g/dL) The effects of DFO to hemoglobin were continued for 15 months after DFO trial with simiral degree through Time I, Time II. Also, rHuEPO dosage used in the experimental group were decreased to simiral levels of the control group after DFO trial and these effect were also continued for 15 months(Time I; mean 48.1 U/Kg/Wk. Time II; mean 51.8 U/Kg/Wk). In the same period, hemoglobin levels and rHuEPO dosages used in the control group were not changed significantly. Notibly, hemoglobin increment and rHuEPO usage decrement in experimental group were showed maxilly in the 1st month after DFO trial. That is, after the use of DFO, erythropoiesis was enhanced with a reduced rHuEPO dosage. So we think rHuEPO reisistancy can be overcome by DFO therapy. In conclusion, the DFO can improve the anemia caused by chronic renal failure at least over 1 year, and hence, can reduce the dosage of rHuEPO for anemia correction. Additional studies in order to determined the mechanism of DFO on erythropoiesis and careful attention to potential side effects DFO will be needed.

Hematology
Modified classification of anemia by RDW.: Hyeong Ki Hwang, Myung Soo Hyun, Bong Sup Shim; Yeungnam Univ J Med. 1993;10(1):58-67. Published online June 30, 1993; DOI: https://doi.org/10.12701/yujm.1993.10.1.58

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Abstract PDF: The author obtained index of red cell volume distribution width(RDW) and other red cell indices in 210 patients of various hematoncologic conditions and 200 healthy control group using, an automated blood analyzer, Coulter Counter Model S-plus II. This study performed to classify various etiologic anemia based on the MCV and RDW, to evaluate availability to the differential diagnosis in korean anemic distoders somewhat different from etiologies of anemias in foreginers. In the most of cases, the increase or decrease of MCV were always combined the pararell changes of MCH and MCHC: But the values of MCV and RDW were not correlated in control group and patient group. So the terms of heterogenous of homogenous anemia were meaningful morphologic classification than hypochromic or normochromic anemia. The heterogenous microcytic anemia contained iron deficiency anemia. In heterogenous normocytic anemia, myelophthisic anemia, acute leukemia were contained. In heterogenous macrocytic anemia, megaloblastic anemia, hemolytic anemia were contained. The homogenous microcytic anemia was observed in anemia of chronic disorders. In homogenous normocytic anemia, acute blood loss, chronic leukemia, multiple myeloma were contained. The aplastic anemia was belonged to homogenous macrocytic anemia. The diagnostic significance of RDW in hemoglobinopathies is most importhant. But this study was not contained hemoglobinopathies. Instead RDW was very helpful to differential diagnosis of most common anemias, iron deficiency anemia and anemia due to chronic disorders in Korea.

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