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kp 2.4.1.2

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    APLASTIC ANEMIA

    Dr dr H IRZA WAHID SpPD KHOM FINASIM

    SUBDIVISION OF HEMATOLOGY & MEDICAL ONCOLOGY

    DEPARTEMENT OF INTERNAL MEDICINE

    FACULTY OF MEDICINE ANDALAS UNIVERSITY

    09-02-2015

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    Hema!"!#$ Da% O%!"!#$ Me'$Hema!"!#$ ( I"m) * Da+a,

    Hem!!e.$. (S)m-.)m )"a%# --------------------------------/ Da+a, e$

    E+$+!!e.$. e+$+!.$ A%em$a P!"$.$em$a Me#aa+$!!e.$. +!m!.$ T+!m!.$!.$. T+!m!.$!e%$a

    G+a%)"!!e.$. "e)!.$ Le)!e%$a Le)!.$!.$.

    M!%!.$!!e.$. m!%!.$ M!%!.$!e%$a M!%!.$!.$.

    L$m3!!e.$. "$m3!.$ L$m3!.$!e%$a L$m3!.$!.$.

    E4+ame')"a+--------------------------------------- / Ha$ L$ma

    O%!"!#$ Me'$ ( I"m) * T)m!+ * N!% S)+#e+

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    ANEMIAPARAMETER ( 6a'a+ ,em!#"!$% Me!'e Sa,"$

    P+$a 'e7a.a ( 8a%$a 'e7a.a ( Ham$" ( H 1: ( 12 ( 11 #+ ;

    GE,+!%$> '$.ea.e

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    A#eSe4 +. Hem!#"!$% #'L Hema!>+$ ;

    C,$"'+e% 05- 110 ::

    C,$"'+e% 5-12 115 :5

    C,$"'+e% 12-15 120 :

    A')" Me% 1:0 :9

    N!%-+e#%a%8!me%

    120 :

    P+e#%a% 8!me% 110 ::

    Anemic Ranges of Hemoglobin and Hematocrit Values

    WHO. Worldwide Prevalence of Anaemia 1993-!!"."

    #$%ese are onl& guidelines and some '%&sicians feel t%e t%res%olds s%ould be %ig%er for adults.

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    De3$%$$!%

    Pe+$,e+a" Pa%>!e%$a A%em$a Le)>!e%$a T,+!m!>!e%$a

    Re$>)"!>!-e%$a

    A"a.$> !%e ma++!7 H!>e"")"a+ 7$, a""

    e"eme%. '!7% m!." 3aa%' .+!ma

    Re.$')a" ,ema!!$e$>

    >e"". a+e %!+ma" N! ma"$#%a%> !+ 3$+!.$. N! me#a"!"a.$>

    ,ema!!$e.$.

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    Se=e+$ !3 D$.ea.e

    Se=e+e A"a.$> A%em$a SAA

    Ma++!7 !3 "e.. ,a% 25; %!+ma" >e"")"a+$

    2 !3 : a%!+ma" e+$,e+a" "!!' =a")e.

    A.!")e +e$>)"!>e >!)% 0000

    ANC500

    P"ae"e. 20000

    Ve+ Se=e+e A"a.$> A%em$a VSAA A!=e 7$, ANC 200

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    H$.!+ !3 A"a.$> a%aem$a

    Pa)" E,+"$>, 1@5-1915 'e.>+$e'

    ,e 3$+. >a.e !3 a"a.$> a%aem$a $% a

    +e#%a% 7!ma% 7,! '$e' !3 ma++!73a$")+e $%1@@@

    T,e e+m a"a.$> a%aem$aJ 3$+.).e' A%a!"e C,a)33a+' $% 190

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    A"a.$> A%em$a e$'em$!"!#

    a%%)a" $%>$'e%>e $% E)+!e a%' US - 2 >a.e. e+

    m$""$!% !)"a$!% ) >a.e. $% Ba%#! $%

    T,a$"a%' a%' 1 $% $a" +e'$.!.$$!% e4$.. $% ,e U%$e'Sae. ,!7e=e+ +e=a"e%>e $. $%>+ea.e' $% ,e

    Fa+ Ea.

    T,e ma"e-!-3ema"e +a$! $. a+!4$mae" 1(1

    A"a.$> a%em$a !>>)+. $% a"" a#e #+!).

    a .ma"" ea $% $%>$'e%>e $% >,$"',!!'

    a ea $%>$'e%>e $% e!"e a#e' 20-25 ea+. a%' a

    ea $% e!"e !"'e+ ,a% 0 ea+.

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    A"a.$> A%em$a - E$!"!#

    C!%#e%$a"$%,e+$e' 20;

    Pa$e%. ).)a"" ,a=e '.m!+,$> 3ea)+e. !+

    ,.$>a" .$#maa O>>a.$!%a"" ma++!7 3a$")+e ma

    e ,e $%$$a" +e.e%$%# 3ea)+e

    Fa%>!%$ a%em$a

    D.e+a!.$. >!%#e%$a

    S,7a>,ma%-D$am!%' .%'+!me

    Fam$"$a" a"a.$> a%em$a

    A>K)$+e'

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    A"a.$> A%em$a( C!%

    A>K)$+e'( D+)#.

    - C!!4$> '+)#. - A%$$!$>.

    - C,"!+am,e%$>!" - A%$-$%3"amma!+

    - A%$->!%=)".a% - S)",!%am$'e.

    - 2-: m!%,. ).)a"" e7ee% e4!.)+e a%' ,e 'e=e"!me% !3 a"a.$> a%em$a

    Ra'$a$!%.

    C,em$>a". e# Be%e%e a%' e.$>$'e.

    V$+).e.( Hea$$. B C

    He+e. .$m"e4

    E-B =$+).

    HIV Imm)%e( SLE RA +,e)ma!$' a+,+$$.

    P+e#%a%>

    PNH

    I'$!a,$> P+$me+ ( 5;

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    Pa,!#e%e.$.

    Imm)%e me>,a%$.m +e.!%.$"e 3!+

    m!. !3 ,e >a.e. !3 I'$!a,$>

    a>K)$+e' a"a.$> a%em$a A>$=ae' C!!4$> T >e"". $% B"!!'

    & B!%e ma++!7 B!%e ma++!7

    3a$")+e

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    C"$%$>a" Fea)+e.

    A%em$a

    B"ee'$%#( E>>,m!.e. B"ee'$%#

    #)m. E$.a4$.

    I%3e>$!%.( Fe=e+M!), )">e+.

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    D$a#%!.$.

    B"!!' e+$,e+a" .mea+ (Pancytopenia and reticulocytopenia

    B!%e ma++!7 a.$+a$!% & $!. (Hypocellular / aplastic bone arro!!it" increased #at spaces

    Te.. 3!+ )%'e+"$%# >a).e $iral titers

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    BM Aspiration BM

    Biopsy

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    BM $!.

    "ypocellular %increased #at spaces

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    Ot"er causes o# Pancytopenia&

    S$#% !3 >!%#e%$a" '$.ea.e

    D+)#. V$+a"

    Me#a"!"a.$> a%em$a

    B!%e Ma++!7 $%3$"+a$!% !+ Re"a>eme%(

    SLE RA

    D$..em$%ae' TB

    PNH

    Se.$.I3 -

    $'$!,a$> !+ +$ma+ a>K)$+e' a"a.$>

    a%em$a

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    A"a.$> A%em$a - T+eame%

    8$,'+a7a" !3 e$!"!#$>a" a#e%.

    Ma%a#eme% !3 )%'e+"$%# '$.e.a.e

    S)!+$=e

    Re.!+a$!% !3 ma++!7 a>$=$( B!%e ma++!7 +a%."a%

    Imm)%!.)+e..$=e +eame%- P+e'%$.!"!%e - A%$"m,!>e #"!)"$%

    - C>"!.!+$%

    - S"e%e>!m

    A%'+!#e%.

    G+!7, 3a>!+.

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    APLASTIC ANEMIA +eame%

    S)!+$=e >a+e

    T+a%.3).$!%T+eame% !3 a%em$a

    T+eame% !3 "ee'$%#

    P+e=e%$!% a%' +eame% !3

    $%3e>$!%

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    Hema!!$e$> .em >e""

    +a%."aa$!% $% .e=e+e a"a.$>

    a%em$a1 A'=a%a#e.

    - >!++e>$!% !3 ,ema!!$e$> 'e3e>

    - "!%#-e+m .)+=$=a"( @0; - 90; HLA-ma>,e' .$"$%#

    '!%!+- ma?!+$ !3 ,e a$e%. aea+ ! e >)+e'

    2 Re.+$>$!%.- a#e e"!7 0

    - .)$a"e '!%!+ a=a$"a"e $% "e.. ,a% :0; .$"$%#

    - 25-0; +$. !3 GVHD

    - 5-15; +$. !3 #+a3 3a$")+e $% m)"$+a%.3).e' a$e%.

    - ,$#, m!+a"$ a3e+ MUD-HSCT

    - .!"$' )m!+. 12;

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    Imm)%!.)+e..$!%

    Imm)%!.)+e..$!% $. NOT >)+a$=e G!a" $. .).a$%e' +em$..$!%

    20-:; ,a=e +e>)++e% a"a.$> a%em$a

    20-:; 'e=e"! >"!%a" '$.!+'e+ PNH MDS !+ a>)e"e)em$a

    C!m$%a$!% ,e+a $. e. A%$,m!>e #"!)"$% ATG 3$+. >,!$>e

    T!4$> .$'e e33e> $. .e+)m .$>%e.. 4 7$, .e+!$'

    Ca% "!7e+ "ae"e >!)%. +a%.3).e +%

    C>"!.!+$%e 3$+. >,!$>e H$#, '!.e >!+$>!.e+!$'. ae+$%# !33

    A"em))ma

    Aa,$!+$%e

    M>!,e%!"ae m!3e$"

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