What is responsible for acute myocardial infarction in combination with aplastic anemia? A case report and literature review

Table 1 Blood test results of the patient

Parameters	Result of first in hospital (2017)	Result of second in hospital (2021)	Reference range
Hemocyte profile
White blood cell	15.52 × 109/L	5.3 × 109/L	4-10 × 109/L
Hemoglobin	157 g/L	149 g/L	120-160 g/L
Platelet count	85 × 109/L	30 × 109/L	100-300 × 109/L
Neutrophil	12.98 × 109/L	3.31 × 109/L	2-7 × 109/L
Lymphocyte	1.49 × 109/L	1.53 × 109/L	0.8-4.0 × 109/L
Monocyte	1.03 × 109/L	0.37 × 109/L	0.12-0.8 × 109/L
Neutrophil%	83.5%	62.4%	50%-70%
Lymphocyte%	9.6%	28.9%	20%-40%
Eosinophil	0.01 × 109/L	0.08 × 109/L	0.05-0.50 × 109/L
Basophil	0.01 × 109/L	0.01 × 109/L	0.00-0.10 × 109/L
Mean corpuscular volume	108.6 fL	113.1 fL	80-100 fL
Mean corpuscular hemoglobin	36.5 pg	38.1 pg	27-34 pg
Platelet volume distribution width	17.4%	16.1%	15%-17%
Mean platelet volume	12.3 fL	10.1 fL	7-11 fL
Hypersensitive troponin Ia	1.76 ng/mL (0-0.04)	0.038 ng/mL (0.01-0.023)
Myoglobina	781.5 ng/mL (0-120)	48 ng/mL (23-112)
Blood urea nitrogen	5.67 mmol/L	5.67 mmol/L	3.2-7.1 mmol/L
Creatinine	91.91 umol/L	90.7 umol/L	58.0-110.0 umol/L
Thromboelastography
Inhibition rate of AA channel	50.4%	75.1%	≥ 50%, with aspirin
inhibition rate of ADP channel	25.9%	28.3%	≥ 30% with ADP inhibitor
Thrombophilia profile
Prothrombin time	10 s	10.5 s	9.4-12.5 s
Prothrombin activity	108%	111%	70%-140%
International normalized ratio	0.93	0.93	0.7-1.4
Fibrinogen	4.1 g/L	3.24 g/L	2.00-4.00 g/L
D-dimer	NK	1.16 ug/mL	0.00-0.50 ug/mL
Lipid profile
Total cholesterol	8.17 mmol/L	5.95 mmol/L	3-5.7 mmol/L
Triglycerides	2.91 mmol/L	2.36 mmol/L	< 1.7 mmol/L
HDL cholesterol	0.74 mmol/L	0.77 mmol/L	1.16-1.42 mmol/L
LDL cholesterol	6.82 mmol/L	4.14 mmol/L	< 4.3 mmol/L
Apolipoprotein A	0.64 g/L	0.88 g/L	0.264-1.362 g/L
Apolipoprotein B	2.81 g/L	1.36 g/L	1.05-1.75 g/L

^aSince the reference values change according to the internal standard of the technology; we included them in parentheses.

Table 2 Cases of anemia complicated with myocardial infarction published in PubMed

Ref.	Biographical information	Age of first diagnosis of AA	AA drug therapy and duration	Location of AMI	Coronary artery (by CAG or autopsy)	Therapy	Prognosis
[8]	61-year-old male	56-year-old	Metenolone enanthate (45mg)	Inferior wall	RCA	NS	NS
	59-year-old female	42-year-old	Metenolone enanthate (100mg) oxymetholone (30 mg)	Inferior wall	RCA	NS	NS
[9]	16-year-old girl	3-year-old	BMT; GVHD: cyclosporine A and azathioprine	Inferior wall	RCA	Stent implantation	Discharge and recover well
[10]	76-year-old man	76-year-old	Cyclosporine A	NSTEMI	LAD,RCA, And LCX	Medical treatment; Recurrent AMI 1 mo later and accepted PCI. Left-sided chronic subdural hematoma after PCI	Heart failure, acute kidney injury, and recurrent AMI
[11]	38-year-old man	32-year-old	Cyclosporin A, granulocyte colony-stimulating factor, corticosteroids and antithymocyte globulin	Anterior wall	LAD	Medical treatment	Death autopsy revealed disseminated aspergillosis
[12]	52-year-old man	NS	Oxymetholone (100 mg/daily) platelet transfusion after in hospital	Anterior wall	LAD in the portion of the previously inserted stent	Balloon angioplasty	Discharged

AA: Aplastic anemia; AMI: Acute myocardial infarction; CAG: Coronary angiography; LAD: Left descending coronary. LCX: Left Circumflex Artery, RCA: Right Coronary Artery; NS: Not Described; NSTEMI: Non-ST-segment Elevation Myocardial Infarction; PCI: Percutaneous coronary intervention.

Table 3 Cases of cardio-cerebrovascular events caused by stanozolol

Ref.	Biographical information	Drug and dose	Duration of use	Diagnosis	Coronary artery (by CAG or autopsy)	Therapy	Prognosis
[16]	30-year-old male	Orally stanozolol 10 mg daily and intramuscularly 250 mg testosterone twice per week	2 mo	Anterior wall AMI	LAD	Medical treatment	Discharged
[17]	25-year-old male	Nandrolone 100 mg/wk stanozolol tablets 25 mg/d	3 wk	Takotsubo cardiomyopathy	N	Medical treatment	Discharged
[18]	26-year-old male	Stanozolol 10 mg daily	3 mo	Ischemic Stroke	N (Angiography of the Cerebral artery)	Medical treatment and rehabilitation	Discharged with severe disability
[19]	28-year-old male	Stanozolol 280mg weekly	2 yr	NSTEMI; ventricular tachycardia	LADRCA	Percutaneous translumind coronary angioplasty	Discharged
[20]	22-year-old male	Stanozolol, 10 mg/d and clenbuterol 40 μg/d for 7 dstanozolol, 20 mg/d and clenbuterol 80 μg/d for 3 d. triiodothy-ronine 25ug/d	10 d	Cardiomyopathy; acute hepatic injury	NS	Medical treatment	Discharged
[21]	29-year-old female	Ephedrine, tadalafil, metandienon, mestanolon, stanozolol	NS	Sudden cardiac death; cardiac arrhythmia	LAD	NA	Sudden cardiac death
[22]	24-year-old male	Stanozolol, testosterone, tamoxifen, mesterolone, and nandrolone	6 mo	Cardiorespiratoryarrest	The left main trunk and LAD	NA	Sudden cardiac death
[23]	24-year-old male	Stanozolol (40 mgs daily) nandrolone 200 mgs intramuscularly twice weekly, Sustanon 250 (testosterone esters) 1 mL intramuscularly once a week	6 wk	Anterior wall AMI	NS	Medical treatment	NS
[24]	37-year-old male	Nandrolone Testosterone cypionate stanozolol; oxandrolone	3-16 wk	Inferior wall AMI	N; Consider spasm	Medical treatment	Discharged

CAG: Coronary angiography; N: Normal; LAD: Left descending coronary; AMI: Acute myocardial infarction; RCA: Right Coronary Artery; NA: Not applicable; NS: Not Described.