Aplastic anemia

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Aplastic anemia

Disturbances in the bone marrow can not be asymptomatic. In the analysis of blood, there will be characteristic changes, namely, all the blood elements will be extremely low level. Certainly, the patient’s quality of life will deteriorate significantly.

Sometimes there is a sharp onset of anemia, when against a background of general health, a person begins to feel badly. At the same time, pathology develops very quickly, and treatment is ineffective. Such a clinical picture is rare. Most often anemia progresses gradually, so a person for a long time may not even know about his terrible diagnosis. The organism plays a “cruel joke”, including adaptive mechanisms, thereby overlapping symptoms of the existing disorder. This does not allow for timely treatment. However, sooner or later, signs of an existing violation still manifest themselves, which causes a person to seek medical help. The defeat of the bone marrow leads to the fact that the patient develops the following pathological syndromes: anemic and hemorrhagic. In addition, the probability of infectious complications increases.

The main symptoms of aplastic anemia are:

  • If, in addition to disturbing the formation of red blood cells in the bone marrow, platelets are insufficiently produced, this will be accompanied by bleeding. The tissues suffer from oxygen starvation, the skin becomes unnatural pallor. The person often experiences headaches, he has attacks of dizziness. With a slight physical effort there is a shortness of breath, which will later develop even in a state of rest. The oral cavity is attacked by various infectious agents. In general, a person experiences constant malaise and very quickly gets tired.

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  • Decrease in platelet count leads to the appearance of subcutaneous hemorrhage, the gums begin to bleed. From time to time there are nasal bleedings, women have increased uterine bleeding.

  • Reducing the number of leukocytes leads to a drop in the body’s immune forces. He will find it increasingly difficult to fight with infections, a person starts to hurt often and for a long time. He has otitis, pneumonia, subcutaneous hemorrhage can be complicated by purulent infections, you can not even exclude sepsis. All diseases are accompanied by a significant increase in body temperature.

  • In the heart there are noises that the doctor can listen to during auscultation.

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  • Erythrocytes in the blood are subjected to massive destruction, which entails the release of hemoglobin into the environment. As a result of the process of hemolysis, the skin of the person begins to give off yellow. Hemolysis is a sign that there is not only a decrease in the level of red blood cells in the blood, but also their qualitative damage.

  • As the disease progresses, the liver and spleen begin to increase in size.

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Acute anemia often develops precisely with the acquired form of the disease. The superheavy degree of the disease progresses very quickly, it is difficult to treat it. Just a few weeks a person may not become. It was found that treatment with levomycetin 10 times increases the likelihood of developing a superheavy aplastic anemia.

Chronic course of the pathological process is most often observed with congenital and hereditary anemia. Periods of calm are followed by periods of exacerbation. With such a clinical picture, there are still chances of a full recovery.

How to treat aplastic anemia?

If a person is diagnosed with aplastic anemia, then treatment should be started immediately. It is necessary to eliminate all factors of influence on the body that could lead to the development of this pathology. If this is not done, then the disease necessarily recurs, which will lead to a deterioration in the state of health, or to death.

Previously, aplastic anemia was treated with androgens and corticosteroid hormones. Modern medicine refuses such therapy, or supplement the reception of oxymetalone and prednisolone with immunosuppressors (Ciclosporin-A and ALG).

It was also previously practiced removal of the spleen, which allowed a few to regulate the hematopoietic function of the bone marrow. Although modern views on the problem of treatment of aplastic anemia do not negate the positive effect of the operation, nevertheless, this method is considered only as an auxiliary one. Assign surgery only to patients with severe anemia, which is not amenable to conservative treatment, or requires regular transfusion of thrombotic mass.

Treatment with hemopoietins is also not has made significant progress. The use of colony-stimulating factors and interleukins allows for a time to increase the level of leukocytes, but does not exert significant influence on the course of the disease.

The only effective method of treating severe anemia is bone marrow transplantation. However, this is a complex operation, the selection of a donor is a serious obstacle to its implementation. Moreover, the procedure is associated with various immunological complications. The probability of rejection of the foreign organ of hematopoiesis remains high.

Diagnosis of aplastic anemia

Diagnosis of the patient begins with a thorough interview of his complaints and with the collection of anamnesis. Be sure to clarify whether there was aplastic anemia in close blood relatives of a person who came to the reception.

In order to confirm or deny the diagnosis, the doctor will assign the following complex of examinations to the patient:

  • Re-surrender of blood to determine the level of reticulocytes and platelets in it.

  • Conducting a biochemical blood test.

  • Puncture of bone marrow puncture, which allows a high probability to detect aplastic anemia.

  • Execution of trepanobiopsy. In this case, fatty degeneration of the cells responsible for the formation of blood cells with the formation of inflammatory infiltrates can be detected. As an option, small foci can be visualized that suppress the production of red blood cells.

The following procedures are used as auxiliary research methods:

  • Cytogenetic study of bone marrow and peripheral lymphocytes. This will detect chromosome aberrations.

  • US of internal organs: liver and spleen. Children also check the thymus gland. Lymph nodes are also examined.

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  • When planning bone marrow transplantation, the typing of HLA class II antigens is performed.

    / The same measure is valid for surgical intervention.

    Differential diagnosis of aplastic anemia with other conditions should be carried out. So, analogous symptoms are metaplastic anemia, which is characterized by proliferation of pathological cells in the bone tissue. This type of anemia is observed against the background of acute leukemia, myeloma, myelofibrosis, with the penetration of bone marrow metastases of other tumors.

    Video lecture: Maschan AA Optimization of treatment for acquired aplastic anemia in children and adolescents:

    Forecast

    Lethal outcome for aplastic anemia develops against a background of various infections, or because of bleeding that can not be stopped. It makes the prognosis less favorable for the treatment with Levomycetin, or for the previously transmitted infectious hepatitis.

    However, considering aplastic anemia as a death sentence is also not true. Modern medicine makes it possible for people not only to prolong life, but also to completely cure.

    The use of immunosuppressors allows to increase the life expectancy of patients with aplastic anemia for 10 years or more. If the patient waits for a bone marrow transplant, then this makes the forecast even more favorable.

    In general, much depends on the specific type of disease. Idiopathic anemia, which does not have a severe course, allows patients to live a long time, and sometimes people completely get rid of it. In any case, the approach to each patient, as well as making a prediction – is strictly individual.

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