Deceased
Kathryn Maree Jelbart
Demographics
59y, female
Coroner
Coroner John Olle
Date of death
2016-03-25
Finding date
2018-01-18
Cause of death
Multiorgan failure and polymicrobial sepsis secondary to severe bone marrow failure due to azathioprine toxicity in setting of TPMT genetic polymorphism
AI-generated summary
A 59-year-old woman with renal transplant died from multiorgan failure and sepsis secondary to severe bone marrow failure caused by azathioprine toxicity. She had an undiagnosed genetic polymorphism (TPMT *3A/*3A homozygous) causing extreme sensitivity to azathioprine's myelosuppressive effects. Azathioprine was substituted for mycophenolate overseas and continued despite subsequent bone marrow suppression. The critical clinical lesson is that TPMT genotyping should be mandatory before prescribing thiopurine-containing medications. The death was preventable through pre-treatment genetic testing, which would have identified her extreme risk and allowed therapeutic alternatives or drastically reduced dosing. This case identified a significant gap in clinical practice that led to policy change at the treating institution.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
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Clinical conditions
Procedures
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