PMC5457924_01
The time course of the laboratory data following the introduction of hemodialysis. After the introduction of hemodialysis, the patient's hemoglobin (Hb) level was <7 g/dL, despite the use of 60 mug of intravenous darbepoetin alfa (DA) once a week for 12 weeks. After the resection of the thyroid cancer tumor, the Hb level increased to 10.2 g/dL at 3 months. This was maintained while the dose of DA was reduced to 30 mug once a week. The operation also normalized the serum level of albumin. In contrast, the serum ferritin level remained high.
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HD and the administration of ESA normalized the WBC (6,960 /muL) and Plt (15.5x104/muL) counts within three weeks. However, her Hb level remained below 7 g/dL, despite the intravenous administration of darbepoetin alfa (DA) (60 mug) once per week for 12 weeks (Fig. 1). Although there was a slight decrease in the patient's serum ferritin level, it remained high (Fig. 1).
A contrast-enhanced computed tomography image of the thyroid gland. A low-density area was observed in the right lobe.
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A computed tomography (CT) scan revealed a tumor mass in the right lobe of the thyroid gland (Fig. 2).
T2-weighted magnetic resonance images of the liver (A) and the basal ganglia in the brain (B). Abnormal hypointensity was observed on T2-weighted magnetic resonance imaging of the liver and brain.
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Abnormal hypointensity was observed on T2-weighted magnetic resonance imaging of the liver, as well as in the bilateral dentate nucleus, caudate nucleus, putamen and thalamus of the brain were observed (Fig. 3); this was compatible with the deposition of iron in these organs.
A genetic analysis performed after obtaining the patient's informed consent revealed a G969S missense mutation in exon 17 of the ceruloplasmin gene.
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A genetic analysis, which was performed after obtaining the patient's informed consent, revealed a G969S missense mutation in exon 17 of the ceruloplasmin gene (Fig. 4).