1
Fifth stage
Medicine
Lec-9
.د
محمد حارث
1/12/2016
Aplastic anemia
Primary idiopathic acquired aplastic anaemia:
The basic problem is failure of the pluripotent stem cells, producing hypoplasia of the bone
marrow with a pancytopenia in the blood.
The diagnosis rests on exclusion of other causes of secondary aplastic anaemia and rare
congenital causes, such as Fanconi’s anaemia.
Clinical features and investigations
symptoms of bone marrow failure,
1.Anaemia
2.Bleeding
2
3. Infection
Complete Blood Count(CBC) :
Pancytopenia.
Reticulocytopenia.
Bone marrow aspiration and biopsy reveal hypocellular marrow.
Treatment
1.The curative treatment for patients under 30 years of age with severe idiopathic aplastic
anaemia is allogeneic Hematopoietic Stem Cell Trasplantation (HSCT) if there is an available
donor.
2. In older patients, immunosuppressive therapy with ciclosporin and antithymocyte
globulin.
• Such patients may relapse or other clonal disorders of haematopoiesis may evolve, such
as paroxysmal nocturnal haemoglobinuria, myelodysplastic syndrome and acute
myeloid leukaemia
Causes of secondary aplastic anaemia
• Drugs
o Cytotoxic drugs
o Antibiotics – chloramphenicol, sulphonamides
o Antirheumatic agents – penicillamine, gold,
o phenylbutazone, indometacin
o Antithyroid drugs
o Anticonvulsants
o Immunosuppressants – azathioprine
• Chemicals
o Benzene toluene solvent misuse – glue-sniffing
o Insecticides – chlorinated hydrocarbons (DDT),
o organophosphates and carbamates
• Radiation
• Viral hepatitis
• Pregnancy
• Paroxysmal nocturnal haemoglobinuria