3- Aplastic anaemia.pdf

Aplastic Anaemia  Pancytopenia: is reduction in the blood count of all the cell lines ↓↓↓ (red cells, white cells and platelets).  causes of pancytopenia are divided into: 1- decreased bone marrow production (e.g. aplastic anaemia), 2- increase...

Aplastic Anaemia  Pancytopenia: is reduction in the blood count of all the cell lines ↓↓↓ (red cells, white cells and platelets).  causes of pancytopenia are divided into: 1- decreased bone marrow production (e.g. aplastic anaemia), 2- increased peripheral destruction (e.g. hypersplenism). Aplastic (hypoplastic) anaemia is defined as pancytopenia resulting from aplasia of the bone marrow.  What is aplasia of the bone marrow? the red active marrow is replaced by fatty non-functioning marrow. causes & classification AA is classified into: 1- congenital AA, 2- acquired AA:  2- acquired AA: a- primary “idiopathic”. b- secondary.  Secondary acquired AA: has many causes:  a- cytotoxic drug. b- ionizing radiation e;g radiotherapy c- chemicals, benzene d. Drugs: *some drugs usually cause marrow depression e;g Busulphan. *other drugs rarely cause marrow depression e;g chloraphenicol e.viruses, e.g. Epstein-Barr virus E.B. virus  Clinical features Features of bone marrow failure: * features of anaemia.  bleeding due to thrombocytopenia Bruising, bleeding gums, epistaxis, menorrhagia  * Infections due to leucopenia. Infections, particularly of the mouth and throat * No organomegaly.  Investigations CBC (complete blood count) ↓ Hb(anaemia) ↓ WBCs (leucopenia) ↓ platelets (thrombocytopenia) (Pancytopenia)  ↓ Reticulocyte count.  Peripheral blood film: * Normochromic normocytic RBCs. Normochromic normocytic anaemia  Bone marrow: is hypoplastic. Red marrow is replaced by fat>75% of the marrow Normal bone marrow biopsy Normal bone marrow Aplastic bone marrow  Management general & specific measures. General: Remove the cause if possible Supportive measures: Supportive Management * Correct the anaemia by blood transfusion.  * Correct thrombocytopenia by platelet concentrate * treat infections, if present or give prophylactic antibiotics.  Specific management: bone marrow transplantation. (hemopoietic stem cell transplantation)  Spontaneous recovery occurs in some cases.