Course title: Hematology (1)Course code: MLHE-201 Supervisor: Prof. Dr Magda Sultan
Outcome: The student will know:
-The causes and pathogenesis of aplastic anemia.
-The diagnosis of aplastic anemia . -The laboratory tests needed for diagnosis
Aplastic Anaemia
.
APLASTIC ANEMIA
• Aplastic anemia is a severe, life threatening syndrome in which production of erythrocytes, WBCs, and platlets has failed.
• Aplastic anemia may occur in all age groups and both genders.
• The disease is characterized by peripheral pancytopenia and accompanied by a hypocellular bone marrow.
Definition of aplastic anaemia.• Peripheral blood pancytopenia and a
hypocellular marrow in which normal marrow is replaced by fat cells.
• Abnormal cells are not found.
Normal Haemopoiesis.• Red cell life span 120 days.• Platelet life span 6 days.• Granulocyte life span < 24 hours.• Constant marrow activity needed to replace
dead cells.
Pathogenesis.• Primary defect or damage to haematopoietic
stem cell.• possible Immunological attack on stem cells. .• Defective microenvironment (i.e. marrow
stromal defect)
Haematopoietic stem cell.
Pathophysiology of aplastic anemia
Aetiology.(Causes )• INHERITED(20%)o Fanconi Anaemiao Dyskeratosis congenitao Shwachman-Diamond
syndromeo Diamond-Blackfan anaemia.
• ACQUIRED(80%)o Idiopathico Drug inducedo Viral (hepatitis, EBV)o Ionising radiationo Toxins (pesticides,
benzene, arsenic)o Pregnancy o leukaemic
Clinical Features.• Anaemia; tiredness & fatigue, palpitations .
• Low white count; recurrent infections .
• Low platelets; easy bruising and bleeding.
Investigations.• CBC ( Hb < 10 g /dl , TLC < 4000 /cmm ,
platelets < 100,000 /cmm )• Reticulocyte count ( decreased )• Blood film.• B12/folate.• Liver function tests• Virology• Bone marrow aspirate & trephine
APLASTIC ANEMIA
–Lab findings»Severe pancytopenia with relative
lymphocytosis (lymphocytes live a long time)»Normochromic, normocytic RBCs »Mild to moderate anisocytosis and
poikilocytosis»Decreased reticulocyte count»Hypocellular bone marrow with > 70% yellow
marrow
Severe Aplastic Anaemia
• Peripheral Blood o Granulocytes <0.5 x 109/lo Platelets <20 x 109/lo Reticulocytes <1%• Marrow trephine• Markedly hypocellular <25% normal
Marrow trephine
HYPOCELLULAR BONE MARROW IN APLASTIC ANEMIA
OTHER HYPOPROLIFERATIVE ANEMIAS
• Renal disease – due to decreased erythropoietin
• Endocrine deficiencies – may lead to decreased erythropoietin production. For example: hypothyroidism leads to decreased demand for oxygen from tissues; decreased androgens in males; decreased pituitary function
Assignement: Topic Student Names
Acquired aplastic anaemia عشري محمد حماده
Training questions :
What are the laboratory findings in aplastic anaemia ?
How to diagnose Aplastic anaemia ?
• Reference book :• Essential Hematology .• Dacie .