Tuesday, March 9, 2010

Aplastic anemia

Aplastic anemia - Acute


 


 

Definition  

A rare hematopoietic disorder, most often due to pluripotent stem cell injury, that results in pancytopenia and hypocellular bone marrow


 

Findings  

* High output heart failure

* Systolic flow murmur

* Angina

* Dyspnea on exertion

* Bleeding gums

* Easy bruising

* Epistaxis

* Excessive and frequent menstruation

* Fatigue

* Fever

* Headache

* Petechiae


 

Tests  

* Peripheral blood smear examination, light microscopy: Blood smear examination is indicated in the initial evaluation of suspected or unexplained anemia.


 

* Bone marrow biopsy, needle or trocar: Bone marrow biopsies allow for analysis of bone marrow contents and cellularity to aid in diagnosis of bone marrow disorders.


 

Complete blood counts show pancytopenia with preservation of lymphocyte count in aplastic anemia. In early cases isolated thrombocytopenia may be the only finding on CBC. The anemia is often macrocytic with reticulocytopenia.  


 

* Complete blood count with white cell differential, manual


 

Severe pancytopenia may be seen with severe folate deficiency. If a folate deficiency megaloblastic anemia is discovered, it must be treated prior to making a diagnosis of aplastic anemia .  


 

* Folic acid measurement, serum


 

Suspected or known anemia  

* Reticulocyte count: The reticulocyte count is essential for differentiating between anemias arising from nonfunctional versus functional bone marrow .


 

Suspected vitamin B12 (cobalamin) deficiency secondary to pernicous anemia  

* Serum vitamin B12 measurement: Serum cobalamin levels below 74 pmol/L indicate a probable cobalamin deficiency .


 

Chest x-rays are useful in diagnosing patients with aplastic anemia who present initially with infection.  

* Plain chest X-ray


 

Post-hepatitic aplastic anemia can occur 2 to 3 months after an acute episode of hepatitis. Liver function testing, along with hepatitis A antibody, hepatitis B surface antigen, and hepatitis C antibody, can aid in diagnosis.  

* Hepatic function panel


 

All patients with aplastic anemia should be screened for systemic lupus erythematosus (SLE) with antinuclear antibody (ANA) and double-stranded DNA antibody (dsDNA). Pancytopenia may occur with SLE if the autoimmune process involves bone marrow or in the rare occurrence of SLE-induced myelofibrosis.  

* ANA measurement


 

All patients with aplastic anemia should be screened for systemic lupus erythematosus (SLE) with antinuclear antibody (ANA) and double-stranded DNA antibody (dsDNA) testing. Pancytopenia may occur with SLE if the autoimmune process involves bone marrow or in the rare occurrence of SLE-induced myelofibrosis.  

* Antibody to double stranded DNA measurement


 

Patients with Fanconi anemia have abnormal or displaced kidneys on abdominal ultrasound. Also, malignant hematologic disorders that cause pancytopenia may cause splenomegaly and/or enlarged lymph nodes, which may be found via ultrasonography.  

* Abdominal ultrasound


 

Differential Diagnosis  

* Myelodysplastic syndrome - Chronic

* Paroxysmal nocturnal hemoglobinuria

* Common acute lymphoblastic leukemia

* Hairy cell leukemia

* Anorexia nervosa - Chronic

* Mycobacteriosis

* Malignant lymphoma

* Myelofibrosis

* Acquired aplastic anemia

* Fanconi's anemia

* Amegakaryocytic thrombocytopenia

* Shwachman syndrome

* Dyskeratosis congenita


 

Treatment  


 

Drug Therapy  


 


 

Aplastic anemia  


 

ANTITHYMOCYTE GLOBULIN EQUINE

Adults: Antithymocyte globulin 15 mg/kg IV over 12-18 hours for 5 days (test dose of 1 mg/100 mL solution must be given prior to initiating 5-day therapy); and on fifth day ADD prednisolone 1 mg/kg/day IV for 9 days, then tapered for 5 days; and on day 14 ADD cyclosporine 5 mg/kg/day orally until blood counts plateau (trough levels maintained between 150 and 250 mcg/L); after 6 months at plateau a very slow tapering can be initiated; at least 3 months required for a response, a second course of therapy may be repeated at this time if first course was unsuccessful


 

CYCLOPHOSPHAMIDE

Adults: 45 mg/kg IV for 4 days


 

FILGRASTIM

Adults: 5 mcg/kg/day subcutaneously


 


 

Aplastic anemic patients at risk for Aspergillus infections  


 

FLUCONAZOLE  


 


 

ITRACONAZOLE  


 


 

Procedural Therapy  


 

* Bone marrow transplant: Bone marrow transplantation is used to treat aplastic anemia, severe myelodysplastic disorders, and infiltrative malignancies of the bone marrow .


 

* Transfusion of packed red blood cells: Patients with a HCT >30% rarely require RBC transfusion; patients with acute anemia and a HCT <21% typically require transfusion .


 

Non-Procedural Therapy  


 

Aplastic anemia  

* Self Care

1 comment:

  1. I''m Charlotte Johnson,65  years old, Here in Edmonton, Canada. With the new herbal mix medicine I purchased from Dr James herbal mix medicine West Africa  was my only way to get rid of my Alzheimer's, the herbal  mix medicine effectively reversed my condition and alleviate all symptoms.  I was initially very hesitant to discuss my Alzheimer but I just hope it can still help someone. I feel this will be very important information for all Alzheimer patients, because the most violent element in society today is ignorance. Be it any condition, a healthy diet and natural herbs and roots medicine from Dr. James is the road to fast recovery. I had suffered Alzheimer for many years, I fought for proper medical recommendation, care  and all form of humane treatment with little improvement I went through many sleepless nights and periods of intense grief, as do most families. I was recommended by a friend to use Dr. James herbal mix medicine for my Alzheimer with high hope and assurance. I never doubted my friend but to contact Dr. James. And purchased His herbal mix medicine which was effective and I finally feel my Alzheimer is gone with no more symptoms. He also told me that he cures diseases such as  Lungs diseases, kidney diseases, Warts, Bipolar disorder, Shingles,  HPV, ALS, CANCER, NEPHROTIC SYNDROME, HIV / AIDS, Herpes virus, Ovarian Cancer, Pancreatic cancers, bladder cancer, prostate cancer, Glaucoma., Cataracts, Macular degeneration, Cardiovascular disease, Autism. Enlarged prostate, Osteoporosis. Alzheimer's disease, psoriasis, Tach Diseases, Lupus, Backache, dementia, skin cancer,.testicular Cancer, Leukemia, HEPATITIS A, B, C, Contact  the great one on his email    greatcureman@gmail.com
    Info @ drjamesherbalmix@gmail.com

    ReplyDelete

SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence