PMID- 29954763
OWN - NLM
STAT- MEDLINE
DCOM- 20181105
LR  - 20200628
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2018
DP  - 2018 Jun 28
TI  - Post-transplant erythrocytosis refractory to ACE inhibitors and angiotensin 
      receptor blockers.
LID - bcr-2018-224622 [pii]
LID - 10.1136/bcr-2018-224622 [doi]
LID - bcr2018224622
AB  - Post-transplant erythrocytosis (PTE) is a condition with elevated haematocrit 
      (hct) in renal allograft recipients. The mainstay of treatment is ACE inhibitors 
      (ACEi) or angiotensin II receptor blockers (ARB), but seldom phlebotomy. PTE must 
      be recognised early to prevent major thromboembolic events. We present a case of 
      PTE that was refractory to blockade of renin-angiotensin system (RAS) by ACEi and 
      ARB and required phlebotomy for control of hct. Our review of medical literature 
      about prevalence and pathophysiology of PTE suggests that approximately 22% of 
      patients with PTE are refractory to ACEi/ARB treatment. There are four plausible 
      pathways that appear to play a role in causing PTE: disruption of erythropoietin 
      regulation, mitogenic effect of the RAS on erythroid lineage, insulin-like growth 
      factor 1 and androgenic stimulation. Presently, there is no unifying hypothesis 
      involving these factors, but refractoriness to ACEi/ARB may represent a distinct 
      subcategory of PTE.
CI  - (c) BMJ Publishing Group Limited 2018. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Vishnu, Prakash
AU  - Vishnu P
AUID- ORCID: 0000-0002-9254-8094
AD  - Department of Hematology and Oncology, Mayo Clinic, Florida, US.
FAU - Moreno Vanegas, Yenny
AU  - Moreno Vanegas Y
AD  - Department of Hematology and Oncology, Mayo Clinic, Florida, US.
FAU - Wadei, Hani M
AU  - Wadei HM
AD  - Department of Transplant Nephrology, Mayo Clinic, Florida, US.
FAU - Rivera, Candido E
AU  - Rivera CE
AD  - Department of Hematology and Oncology, Mayo Clinic, Florida, US.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20180628
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - JMS50MPO89 (Losartan)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Angiotensin Receptor Antagonists/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Aspirin/*therapeutic use
MH  - Hematocrit
MH  - Humans
MH  - Kidney Transplantation/*adverse effects
MH  - Losartan/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Pancreas Transplantation/*adverse effects
MH  - Phlebotomy/methods
MH  - Polycythemia/*blood/drug therapy/etiology
MH  - Treatment Outcome
PMC - PMC6040554
OTO - NOTNLM
OT  - haematology (drugs and medicines)
OT  - renal transplantation
COIS- Competing interests: None declared.
EDAT- 2018/06/30 06:00
MHDA- 2018/11/06 06:00
PMCR- 2020/06/28
CRDT- 2018/06/30 06:00
PHST- 2018/06/30 06:00 [entrez]
PHST- 2018/06/30 06:00 [pubmed]
PHST- 2018/11/06 06:00 [medline]
PHST- 2020/06/28 00:00 [pmc-release]
AID - bcr-2018-224622 [pii]
AID - 10.1136/bcr-2018-224622 [doi]
PST - epublish
SO  - BMJ Case Rep. 2018 Jun 28;2018:bcr2018224622. doi: 10.1136/bcr-2018-224622.