A 30-month-old boy with aplastic anemia caused by electrocution
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LETTER TO THE EDITOR
A 30-month-old boy with aplastic anemia caused by electrocution Karo Servatyari 1 & Borhan Moradveisi 2 & Hero Yazdanpanah 1 & Andrea Bacigalupo 3 Received: 1 July 2020 / Accepted: 15 July 2020 # Crown 2020
Dear Editor, Aplastic anemia (AA) is a rare and life-threatening disease caused by bone marrow failure that has a high mortality rate if not treated [1]. Electrical injury is a physiological reaction caused by the passage of electricity through the body and shows a very high rate of disability. Electricity and the resulting burns have many long-term and short-term effects [2]. One of the most important side effects is secondary infections [3]. We report an Iranian 30-month-old boy, from a healthy parent and normal developmental period and free of any disease, who suddenly had severe electrical shock after playing with a 220 V outlet. In the first week, the patient had no specific symptoms but 1 week later, the patient developed progressive fatigue, paleness, ecchymosis of the right leg, multiple petechiae and purpura, and bilateral buccal mucosal ulcers. Pancytopenia and an empty bone marrow biopsy were consistent with the diagnosis of aplastic anemia (Fig. 1). The patient had no splenomegaly or hepatomegaly or lymphadenopathy on examination. The patient’s parents denied the use of drugs, radiation during pregnancy, or exposure to chemicals, such as benzene. The patient’s mother has no history of taking any drugs during pregnancy. The results of the patient’s tests are shown in Table 1. The patient was hospitalized several times due to a decrease in platelets and pancytopenia. A bone marrow transplant was
performed, and the patient had trilineage hematologic recovery, returning to a normal life. The cause and mechanism leading to pancytopenia and bone marrow suppression in electrocution (electric field) have not been fully elucidated in any studies. Injuries caused by electric shock due to its direct effect on the cell membrane and vascular smooth muscle cause tissue damage [4]. One case was reported in 1984, and described a 19-year-old man struck by a 20 kV high-voltage electric shock: the patient died after 4 days due to ventricular arrhythmia. At the time of death, the patient was leukopenic, and at autopsy, a decreased bone marrow cellularity with decreased myelopoiesis was recorded [5]. An animal study by Asko-Seljavaara concluded that burns inhibited bone marrow function in rats [6]. Although we cannot prove that bone marrow failure was the consequence of electrocutions, we believe that reporting this case may alert other hematologist who may have seen the same combination. It might also be possible to investigate, in the animal model, the effect of different electrical voltage on myelopoiesis.
* Andrea Bacigalupo [email protected] 1
Kurdistan University of Medical Sciences, Sanandaj, Iran
2
Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
3
Instituto di Ematologia, Fondazione Policl
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