Saptaparna Dasgupta, Bennett University
Rituximab being a revolutionary monoclonal antibody, owing up to the mode of action as a potent therapeutic in targeting CD20 cells, has a strong impact on autoimmune health, including systemic lupus erythematosus. Thrombocytopenia, a rare illness, following rituximab is seen to give rise to haematological malignancy. As autoimmune disorders are rare in occurrence, acutely isolated thrombocytopenia within systemic lupus erythematosus goes unreported. The patient reported was a 36-year-old, suffering from systemic lupus erythematosus, was monitored with the response effect of rituximab. The resultant showed negative effects on the patient when rituximab was withheld. Thus, the working clinical diagnosis was regarded as rituximab-induced acute thrombocytopenia.
Response of Rituximab to Systemic Lupus Erythematosus
Rituximab was produced from deoxyribonucleic acid technology with the help of the human and mouse genes which work via CD20 receptors. Rituximab possesses immune-modulating effects along with biological activity, a variety of autoimmune diseases has been treated with its use. B cells have been recognized for good clinical effectiveness and have a multifunctional role in the treatment of systemic lupus erythematosus. The depletion of systemic lupus erythematosus by targeting CD20 through the usage of rituximab are suitable to reduce severe forms of systemic lupus erythematosus that are refractory to therapy. The usage of rituximab also includes a probable list of potential adverse effects and might affect the haematological and lymphatic systems. Anaemia, Leukopenia, and thrombocytopenia can be caused by the observed spectrum of known hematologic disorders across all cell lines.
The study
South Asian 36-year-old woman diagnosed with systemic lupus erythematosus, class IV lupus nephritis and hypertension since 2012. She possessed no relevant medical, surgical, allergy or family history. She was treated with several doses of oral medications (Table 1). She was observed to have maintained hemodynamic parameters, heart rates, a good count of white blood cells, platelets, and haemoglobin. Also, the tests depicted good stats in renal function, inflammatory markers, and urinalysis. After analysis, mycophenolate mofetil was changed to azathioprine, given 50 mg two times per day, which still demonstrated persistent proteinuria, thus indicating failure of both mycophenolate mofetil and azathioprine. The first dose of intravenous rituximab was given to the patient thereafter.
Treatment with Rituximab
Ten days after the therapy with rituximab, the patient suffered continuous bleeding from the mouth and nose for an entire day. Along with the bleeding patchy ecchymotic lesions were also observed throughout her body. Further, oozing of blood without any crusting was noticed through the hard palate and gums in her mouth. Also, the tip of her spleen had turned noticeably soft. This revealed acute thrombocytopenia, having shown a drastically stunted rate of platelet count. The bone marrow biopsy revealed an abundance of megakaryocytes in the bone marrow. The second cycle (post five days) of rituximab depicted good results and led to the rise in her count of platelets (Fig 1). The peripheral lymph nodes of the patient were kept under constant monitoring and her platelet count was kept at a check.
Discussion and conclusion remarks
Isolated thrombocytopenia after usage of rituximab is observed at par with haematological illnesses such as lymphoma non-Hodgkin and leukaemia. The patient after treatment with rituximab had regular platelet levels and had a normal clinical assessment. After the occurrence, an evaluation of the bone marrow and computed tomography did not disclose any evident underlying symptoms which may account for or associate with low platelet counts. A platelet damaging mechanism was shown in the bone marrow. Under the lack of clear guidelines and consensus in such a unique clinical circumstance, an aggressive therapy was selected to take caution. It remains questionable if immunosuppressive treatment has any effect or if there has been self-resolution.
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REFERENCE
- Yudhishdran, J., Sivakumar, J., Navinan, M. R., & Bandapatti, S. (2021). Rituximab induced acute thrombocytopenia in a patient with systemic lupus erythematosus: A case report. Journal of Medical Case Reports, 15(1), 339. https://doi.org/10.1186/s13256-021-02950-y
Author info:
Saptaparna Dasgupta, currently a B. Tech 3rd year student, pursuing Biotechnology, is a diligent student and determined in terms of her career goals. Being a budding biotechnologist, she is open to all research fields of her course and passionate about knowledge. She is focused and constantly tries to improve her writing skills, also a project enthusiast and is fond of gaining hands-on experience in laboratories. She believes that all hard work and efforts pays off eventually and follows this as the motto of her life. Check out some of her works at:
- Dasgupta, S. (2021, June 22). Etheno Adducts of Nucleic Acids and their Carcinogenic Aspects – BioXone. https://bioxone.in/news/worldnews/etheno-adducts-of-nucleic-acids-and-their-carcinogenic-aspects/
- Dasgupta, S. (2021, June 28). The Venomous Doratifera vulnerans as the Savior of Life – BioXone. https://bioxone.in/news/worldnews/the-venomous-doratifera-vulnerans-as-the-savior-of-life/
- Dasgupta, S. (2021, June 30). Pfizer and Moderna: Long-Lasting Protection Against COVID-19 – BioXone. https://bioxone.in/news/worldnews/pfizer-and-moderna-long-lasting-protection-against-covid-19/
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