Blood disease can be misdiagnosed easily, doctors say

By Alison Hsiao  /  Staff reporter

Sat, Jun 08, 2013 - Page 3

Vasculitis is often misdiagnosed as its symptoms vary greatly, depending on the blood vessels and the organs that are affected, the Taiwan Rheumatology Association said yesterday.

Vasculitis is a term for diseases involving the inflammation of blood vessels. It can cause fibrinoid necrosis, or tissue death, which obstructs the flow of oxygenated blood and jeopardizes the health of the affected organ, director-general of the association Gregory Tsay (蔡嘉哲) said.

“Symptoms vary according to which organ has been affected, with blood in urine if the kidney is impaired and coughing up blood if lungs are damaged,” he said.

Vasculitis can be classified into three categories according to the size of the vessels affected: large-vessel, medium-vessel and small-vessel vasculitides, Tsay said.

“Among them, three small-vessel vasculitides — Wegener’s granulomatosis, microscopic polyangiitis and Churg-Strauss syndrome — are called ANCA [anti-neutrophil cytoplasmic antibodies]-associated vasculitides, in which ANCA can be detected in the patient’s blood,” he said.

Doctors are advised to take extra caution when treating patients with common symptoms such as fever and fatigue “as prolonged fever and a low red blood cell count can indicate small-vessel vasculitides,” he added.

Hsieh Song-chou (謝松洲), attending physician at the Division of Rheumatology, Immunology and Allergy at National Taiwan University Hospital, said that the chance of being misdiagnosed is high, adding that many of his patients who suffer from the disease were previously misdiagnosed as having paranasal sinusitis.

“The misdiagnosis may delay proper medical intervention, and the traditional treatment for ANCA-associated vasculitides, using cyclophosphamide which is used to treat cancers and autoimmune disorders, and steroids, are accompanied by serious side-effects,” Hsieh said. “The former is associated with adverse drug reactions, such as bone marrow suppression, bladder damage and infertility, while the latter’s side effects include cataracts, osteoporosis, hypertension, obesity and high blood sugar levels.”