Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766 |
Resumo: | Introduction: Hemolytic anemia may be associated with multiple etiologies, including toxic substances, such as metals, which is a rare cause.Case Study: 55-year-old male, who underwent a total arthroplasty of the right hip (uncemented prostheses with ceramic-ceramic articulation with an acetabular component consisting of a dome composed of an alloy of titanium, aluminum and vanadium into which fitted a ceramic ‘insert’). Approximately 4 years after surgery the patient complained of noise originating from the prosthesis which occurred on movement. A surgical revision was performed and showed the presence of dark thick intracapsular fluid, fracture of the ceramic acetabular ‘insert’ and signs of wear of the acetabular metal dome. Extensive washing was carried out and the fractured ceramic ‘insert’ was replaced for a polyethylene ‘insert’. Two months later he was referred to the Emergency Room due to worsening of his general health, floating in the right hip and mucocutaneous jaundice. Laboratory tests suggested autoimmune hemolytic anemia. Arthrocentesis was performed and a large volume of metal fluid was drained off. The CT scan showed a large heterogeneous pelvic cystic collection seeded with prosthesis fragments, suggestive of metallosis. Hemolytic anemia was explained as toxicity of the particles and metal ions caused by the wear of the prosthesis. The patient was started on a high-dose steroid treatment. Afterwards, when he was stable, prosthesis components replacement and drainage of pelvic debris fluid were carried out.Discussion: After the fracture of the ceramic ‘insert’ the ceramic head began to articulate directly with the metallic acetabular component, causing noise and wear with release of particles and ions. This caused a cystic pelvic abscess, which went unnoticed on the first surgical revision. Surgical debridement lead to the cystic collection extending into the adjacent tissues and the systemic circulation, triggering serious systemic effects, such as autoimmune hemolytic anemia. The potential toxicity of each of the metal elements of this prosthesis is unknown, and there are still no available laboratory tests for its detection.Conclusion: Metallosis is a rare cause of autoimmune hemolytic anemia. |
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Metallosis: A Rare Cause of Autoimmune Hemolytic AnemiaMetalose: Causa Rara de Anemia Hemolítica AutoimuneAnemiaHemolyticAutoimmuneArthroplastyJaundiceMetals/adverse effects.Anemia Hemolítica Auto-ImuneArtroplastiaIcteríciaMetais/efeitos adversos.Introduction: Hemolytic anemia may be associated with multiple etiologies, including toxic substances, such as metals, which is a rare cause.Case Study: 55-year-old male, who underwent a total arthroplasty of the right hip (uncemented prostheses with ceramic-ceramic articulation with an acetabular component consisting of a dome composed of an alloy of titanium, aluminum and vanadium into which fitted a ceramic ‘insert’). Approximately 4 years after surgery the patient complained of noise originating from the prosthesis which occurred on movement. A surgical revision was performed and showed the presence of dark thick intracapsular fluid, fracture of the ceramic acetabular ‘insert’ and signs of wear of the acetabular metal dome. Extensive washing was carried out and the fractured ceramic ‘insert’ was replaced for a polyethylene ‘insert’. Two months later he was referred to the Emergency Room due to worsening of his general health, floating in the right hip and mucocutaneous jaundice. Laboratory tests suggested autoimmune hemolytic anemia. Arthrocentesis was performed and a large volume of metal fluid was drained off. The CT scan showed a large heterogeneous pelvic cystic collection seeded with prosthesis fragments, suggestive of metallosis. Hemolytic anemia was explained as toxicity of the particles and metal ions caused by the wear of the prosthesis. The patient was started on a high-dose steroid treatment. Afterwards, when he was stable, prosthesis components replacement and drainage of pelvic debris fluid were carried out.Discussion: After the fracture of the ceramic ‘insert’ the ceramic head began to articulate directly with the metallic acetabular component, causing noise and wear with release of particles and ions. This caused a cystic pelvic abscess, which went unnoticed on the first surgical revision. Surgical debridement lead to the cystic collection extending into the adjacent tissues and the systemic circulation, triggering serious systemic effects, such as autoimmune hemolytic anemia. The potential toxicity of each of the metal elements of this prosthesis is unknown, and there are still no available laboratory tests for its detection.Conclusion: Metallosis is a rare cause of autoimmune hemolytic anemia.Introdução: A anemia hemolítica pode estar associada a múltiplas etiologias, nomeadamente a tóxicos, como os metais, sendo esta uma causa rara.Caso Clínico: Homem de 55 anos de idade, sujeito a artroplastia total da anca direita (prótese não cimentada com articulação cerâmica-cerâmica, cujo componente acetabular era constituído por uma cúpula metálica composta por uma liga de titânio, vanádio e alumínio na qual encaixava um insert cerâmico). Cerca de quatro anos após esta intervenção cirúrgica referia ruídos na prótese com os movimentos. Foi sujeito a revisão cirúrgica tendo-se constatado a presença de líquido espesso intracapsular de cor escura, fractura do insert acetabular cerâmico e sinais de desgaste da cúpula metálica acetabular. Procedeu-se a lavagem abundante e substituição do insert cerâmico fracturado por um insert de polietileno. Dois meses depois recorreu ao Serviço de Urgência por degradação do estado geral, flutuação na anca direita e icterícia muco-cutânea. Analiticamente evidenciava valores compatíveis com anemia hemolítica autoimune. Foi feita punção articular com saída de abundante líquido metalótico. A tomografia computorizada revelou extensa colecção heterogénea quística intrapélvica com múltiplos fragmentos de prótese no seu interior, sugestivos de metalose. A anemia hemolítica foi interpretada como consequência da toxicidade das partículas e iões metálicos oriundos do desgaste da prótese. Iniciou corticoterapia em altas doses e posteriormente quando houve condições procedeu-se à substituição de todos os componentes da prótese e drenagem do material acumulado intra-pélvico.Discussão: Após a fractura do insert cerâmico a cabeça cerâmica passou a articular directamente com o componente acetabular metálico, originando os ruídos e desgaste com libertação de partículas e iões. Este material formou uma coleção quística intrapélvica, que passou despercebida na primeira revisão cirúrgica. O desbridamento cirúrgico pôs em comunicação esta coleção com os tecidos adjacentes e com a circulação sistémica, desencadeando efeitos sistémicos graves, como anemia hemolítica auto-imune. Desconhece-se o potencial de toxicidade de cada um dos elementos metálicos desta prótese, não estando ainda disponíveis testes laboratoriais de detecção.Conclusão: A metalose é uma causa rara de anemia hemolítica auto-imune.Ordem dos Médicos2015-04-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/mswordapplication/pdfapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766oai:ojs.www.actamedicaportuguesa.com:article/5766Acta Médica Portuguesa; Vol. 28 No. 3 (2015): May-June; 386-389Acta Médica Portuguesa; Vol. 28 N.º 3 (2015): Maio-Junho; 386-3891646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/4353https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7361https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7362https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7363https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7364https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7539https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7560https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7561https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7598Duarte, JoanaCorreia, LurdesSimão, AdéliaFigueiredo, AntónioCarvalho, Armandoinfo:eu-repo/semantics/openAccess2022-12-20T11:04:28Zoai:ojs.www.actamedicaportuguesa.com:article/5766Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:09.802842Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia Metalose: Causa Rara de Anemia Hemolítica Autoimune |
title |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
spellingShingle |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia Duarte, Joana Anemia Hemolytic Autoimmune Arthroplasty Jaundice Metals/adverse effects. Anemia Hemolítica Auto-Imune Artroplastia Icterícia Metais/efeitos adversos. |
title_short |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
title_full |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
title_fullStr |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
title_full_unstemmed |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
title_sort |
Metallosis: A Rare Cause of Autoimmune Hemolytic Anemia |
author |
Duarte, Joana |
author_facet |
Duarte, Joana Correia, Lurdes Simão, Adélia Figueiredo, António Carvalho, Armando |
author_role |
author |
author2 |
Correia, Lurdes Simão, Adélia Figueiredo, António Carvalho, Armando |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Duarte, Joana Correia, Lurdes Simão, Adélia Figueiredo, António Carvalho, Armando |
dc.subject.por.fl_str_mv |
Anemia Hemolytic Autoimmune Arthroplasty Jaundice Metals/adverse effects. Anemia Hemolítica Auto-Imune Artroplastia Icterícia Metais/efeitos adversos. |
topic |
Anemia Hemolytic Autoimmune Arthroplasty Jaundice Metals/adverse effects. Anemia Hemolítica Auto-Imune Artroplastia Icterícia Metais/efeitos adversos. |
description |
Introduction: Hemolytic anemia may be associated with multiple etiologies, including toxic substances, such as metals, which is a rare cause.Case Study: 55-year-old male, who underwent a total arthroplasty of the right hip (uncemented prostheses with ceramic-ceramic articulation with an acetabular component consisting of a dome composed of an alloy of titanium, aluminum and vanadium into which fitted a ceramic ‘insert’). Approximately 4 years after surgery the patient complained of noise originating from the prosthesis which occurred on movement. A surgical revision was performed and showed the presence of dark thick intracapsular fluid, fracture of the ceramic acetabular ‘insert’ and signs of wear of the acetabular metal dome. Extensive washing was carried out and the fractured ceramic ‘insert’ was replaced for a polyethylene ‘insert’. Two months later he was referred to the Emergency Room due to worsening of his general health, floating in the right hip and mucocutaneous jaundice. Laboratory tests suggested autoimmune hemolytic anemia. Arthrocentesis was performed and a large volume of metal fluid was drained off. The CT scan showed a large heterogeneous pelvic cystic collection seeded with prosthesis fragments, suggestive of metallosis. Hemolytic anemia was explained as toxicity of the particles and metal ions caused by the wear of the prosthesis. The patient was started on a high-dose steroid treatment. Afterwards, when he was stable, prosthesis components replacement and drainage of pelvic debris fluid were carried out.Discussion: After the fracture of the ceramic ‘insert’ the ceramic head began to articulate directly with the metallic acetabular component, causing noise and wear with release of particles and ions. This caused a cystic pelvic abscess, which went unnoticed on the first surgical revision. Surgical debridement lead to the cystic collection extending into the adjacent tissues and the systemic circulation, triggering serious systemic effects, such as autoimmune hemolytic anemia. The potential toxicity of each of the metal elements of this prosthesis is unknown, and there are still no available laboratory tests for its detection.Conclusion: Metallosis is a rare cause of autoimmune hemolytic anemia. |
publishDate |
2015 |
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2015-04-30 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/4353 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7361 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7362 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7363 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7364 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7539 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7560 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7561 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5766/7598 |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 28 No. 3 (2015): May-June; 386-389 Acta Médica Portuguesa; Vol. 28 N.º 3 (2015): Maio-Junho; 386-389 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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