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Diagnosis:
Ulcerative colitis, severe form, total involvment, grade III activity. Secondary iron-deficient anemia.
Case Report
Patient Tk.V.D., male, 28 y. o., admitted to the clinic on August 28, 1996. He complained of frequent stools (10 times per day) with blood and mucus, loss of weight, vertigo, general weakness.
The patient has been sick for 1 month. The onset was sudden; within 3 days, stools became frequent (up to 15 times a day); each time stools had significant amount of blood (near 30 ml). The patient have not been treated; have hemorrhoids. Loss of weight near 17 kg.
By the time of examination (May 3, 1996) general condition was severe. Skin is pale and wet, skin turgor decreased. Cardiac sounds are weak, apical systolic murmur; PS 90/min; AT 100/60 mm Hg. Vesicular respiration in the lungs. The abdomen is soft, normal shape, painful in palpation within left iliac region; sigmoid is narrowed, dense and painful. No peritoneal symptoms. Normal body temperature.
RRS investigation: Examination up to 10 cm. Mucous coat is hyperemic, features contact bleeding, loose, with erosion and pseudopolyps. Conclusion: ulcerative colitis.
Colonoscopy: injured area extends above ileocecal valve and to the whole colon as a diffusive erosive process, smoothed of gaustration, absence of vascular pattern. Intestine lumen contains significant amounts of mucus, blood and pus. Intestine is shortened and tubular-shaped. Conclusion: ulcerative colitis, total involvment.
Blood count: erythrocytes 3.1*1012/l; Hb 100 g/l; leukocytes 12.6*109/l (E-3, yu-2, n-17, s-57, lym-11, m-10, anisocytosis+).
Urinalyses: yellow, acidic, 1015, protein, 0.264 g/l; squamous epithelium, significant amount; polymorphous epithelium, abundant; Le 10-12; erythrocytes, low-measurable, 2-4; urinary cast, 5-7 (with deposit of leukocytes); hyaline cast, 4-6; epithelial cast, 2-4; mucus - significant amount.
Diagnosis: ulcerative colitis, severe form, total involvment, activity of grade III. Secondary iron-deficient anemia.
The patient received basic therapy: sulfasalazine 0.5x2 tablets 4 times per day; metronidazol 0.5x3 times per day; diasolin 3 times per day; festal 4 times per day; vitamines B1, B6, B12, C.
Due to rapid progress of disease, ineffectivness of conservative therapy and significant loss of weight, it has been decided to transplant hematopoietic human fetal liver cells. Intravenous transfusion of the cells was carried out on September 5. Cryopreserved cells of gestational age 12 weeks were administered intravenously, in count of 3.83*108.
Already during transfusion (30 to 40 minutes from the beginning) the patient noted flood of strength. The next day the patient reported better than usual sleep, improved appetite, increased blood circulation in hands and feet. He also noted disappearance of blood in stools. Within the next two weeks, frequency of stools decreased and by September 19 was 2 to 3 times a day; stools did not contain any pathologic admixtures, and was pasty.
Blood count: erythrocytes 2.92*1012/l; Hb 90 g/l; reticulocytes 1.7%; leukocytes, 8.6*109/l (e-6, n-13, s-41, n-28, m-9).
On September 19, repeated transplantation of hematopoietic human fetal liver cells was carried out. Cryopreserved cells, in the age of 12 weeks of gestation, were administered intravenously, in count of 1.87*108. Both transfusions were not associated with any adverse reactions.
On the 3rd day (September 22, 1996) patient demonstrated signs of a viral infection: catarrhal symptoms, fever (up to 38.50C). Stools frequency did not change.
On September 23, the patient was discharged from the clinic for further treatment under ambulatory conditions. 2 weeks after the second (and one month after the first) transplantation, the frequency of stools was 1 time a day; stools had normal consistency, without any admixtures. The patient gained 4 kg of weight. Now he feels good and keeps to a diet.
Blood count: erythrocytes 2.74*1012/l; Hb 90 g/l; leukocytes 5.4*109/l (e-3, n-9, s-65, l-22, m-1; ESR 12 mm/hr).
Because of residual anemic syndrome, the iron preparations were administered; it was also decided to carry out third transplantation of hematopoietic human fetal liver cells.
Transplantation was carried out on October 16, 1996. Cryopreserved cells, in the age of 7 weeks of gestation, were administered intravenously, in the count of 8.28*107. On the next day, the patient noted improvement of general condition and appetite. On the 3rd day, blood admixture appeared in stools, and stools frequency increased up to 4 times a day. On the 7th day stools frequency normalized. The patient continued taking Salofalk for 1 month more.
Average blood count on the 8th day from transplantation: erythrocytes 3.4*1012/l; Hb 110 g/l; CI 0.9; leukocytes 6.2*109/l (n-10, s-63, l-23, m-3, ESR 4 mm/hr).
Hematological indices were stable during subsequent 4 months; after 6 months, erythrocytes were 3.8*1012/l; Hb 120 g/l; CI 0.9; leukocytes 5.2*109/l (n-6, s-69, e-1, n-23, m-1, ESR 3 mm/hr).
At present, the total period of observation is 11 months. The patient is now in stable clinical and hematological remission: he feels good, does not take any medicinal preparations. He gained weight (16 kg). The patient came back to normal working activities.
Head of the Cell Therapy Clinic
of National Medical University and Center "EmCell"
professor Alexander Smikodoub
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