This document discusses aplastic anemia, which is a condition characterized by pancytopenia (low red blood cells, white blood cells, and platelets) due to bone marrow failure. It can be acquired through exposure to drugs, radiation, chemicals, or viruses, or inherited through conditions like Fanconi anemia. Clinically, it presents with anemia, bruising, and increased infection risk. The bone marrow appears hypocellular on biopsy. Treatment involves managing symptoms, stopping any triggers, and attempts to restore bone marrow function through transplantation, immunosuppression, or growth factors.
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
AML:ACUTE MYELOID LEUKAEMIA
for medical colleges teaching faculty and students as well. it includes AML causes , histopathological slides of subclasses of Acute myeloid leukemia, classification , diagnosis, management modalities, complications .Acute leukemias are stem cell disorders characterized by malignant neoplastic proliferation and accumulation of immature and non functional hematopoietic cells in the bone marrow.
The neoplastic cells show increased proliferation and/or decreased apoptosis.
If the defect primarily affects the common myeloid progenitor (CMP) then it is called Acute myeloid leukemia.
Acute myeloid leukemia (AML) is a neoplastic disease characterized by infiltration of the blood, bone marrow, and other tissues by proliferative, clonal undifferentiated cells of the hematopoietic system.
AML is the result of a sequence of somatic mutations in a multipotential primitive hematopoietic cell or, in some cases, a more differentiated progenitor cell.
It can be slow growing or rapidly fatal.
AML is the predominant form of leukemia during the neonatal period
Incidence : 1.5/100,000/year in infants decreases to approximately 0.4 per 100,000 children ages 5 to 9 years, increases gradually to 1.0 persons per 100,000 until age 25 years, and thereafter increases exponentially until the rate reaches approximately 25/100,000 persons.
AML accounts for 15 to 20 percent of the acute leukemias in children and 80 percent of the acute leukemias in adults.
Men > Women (4.5 : 3)
HEREDITY
1) Chromosomal aneuploidy like Trisomy 21 noted in Down syndrome
2) Defective DNA repair, e.g., Fanconi anemia, Bloom syndrome, and Ataxia telangiectasia
3) Congenital neutropenia ie Kostmann syndrome
4) Germline mutations of CCAAT/enhancer-binding protein α (CEBPA), runt-related transcription factor 1 (RUNX1), and tumor protein p53 (TP53) have also been associated with a higher predisposition to AML
RADIATION
Peaks after 5 to 7 yrs of exposure.
Therapeutic radiation alone seems to add little risk of AML but can increase the risk in people also exposed to alkylating agents.
CHEMICAL AND OTHER EXPOSURES
Exposure to benzene, plastic, rubber, petroleum products, paint, ethylene oxide, herbicides and pesticides can increase the risk.
Smoking can also increase the risk
DRUGS
Anticancer drugs are the leading cause of therapy-associated AML.
Alkylating agent–associated leukemias occur on average 4–6 years after exposure, and affected individuals have aberrations in chromosomes 5 and 7.
Topoisomerase II inhibitor–associated leukemias occur 1–3 years after exposure, and affected individuals often have aberrations involving chromosome 11q23.
Other agents like Chloramphenicol, phenylbutazone, and, less commonly, chloroquine and methoxypsoralen.
SYMPTOMS :
Present with nonspecific symptoms initially.
Fatigue is the first symptom
Fever with or without infection will be present in approximately 10% patients
Bleeding, easy bruising
occasional
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Roles have been suggested for a variety of factors, including genetic causes, environmental or occupational causes,radiation, chronic inflammation, and infection .
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7. Aplastic Anemia
Definition:
Pancytopenia with hypocellularity (Aplasia) of
Bone Marrow
Aplastic anemia is a severe, life threatening
syndrome in which production of erythrocytes,
WBCs, and platlets has failed.
8. Aplastic anemia may occur in all age
groups and both genders.
Failure of the bone marrow percursors to
produce mature cells. Characterized by
hypocellular marrow and pancytopenia.
9. Etiology
Acquired: More common
Inherited: Fanconi anemia
Acquired:
Idiopathic: 65%
1. Drugs
Inevitable:
Dose related , reversible.g. cytotoxic drugs, ionizing radiation.
The timing, duration of aplasia and recovery depend on the dose.
Recovery is usual except with whole body irradiation.
e.g., chemotherapeutic drugs)
10. Idiosyncratic:
Unpredictable to drugs e.g., anti-inflammatory antibiotics,
anti-epileptic, these agents usually do not produce
marrow failure in the majority of persons exposed to
these agents.
- Cytotoxic drugs - Antibiotics
- Chloramphenicol - Anti-inflammatory
- Anti-convulsant - Sulphonamides
11. Aplastic Anemia: (Cont.)
Acquired:
Radiations
Chemicals e.g., Benzene and pesticides
Viruses:
– Hepatitis A, Non-A and Non-B
– Herpes simplex
– E-B virus
– Parvovirus: Transient
Immune: SLE, RA (rheumatoid arthritis)
13. substantial reduction in the number of haemopoietic
pluripotential stem cells, and a fault in the remaining
stem cells or an immune reaction against them, which
makes them unable to divide and differentiate
sufficiently to populate the bone marrow.
A primary fault in the marrow microenviromnent has
also been suggested but the success of stem cell
transplantation (SCT) shows this can only be a rare cause
because normal donor stem cells are usually able to
thrive in the recipient's marrow cavity.
14. Pathogenesis
Potential mechanisms:
• Absent or defective stem cells (stem cell failure).
• Abnormal marrow micro-environment.
• Inhibition by an abnormal clone of hemopoietic cells.
• Immune mediated suppression of hematopoiesis.
It is believed that genetic factors play a role. There
is a higher incidence with HLA (11) histo comp.
Antigen. Immune mechanism is involved.
15. Pathogenesis (Cont…)
The latest theory is:
there is an intrinsic derangement
of hemopoietic proliferative capacity, which is consistent
with life. The immune mechanism I,e autoreactive T cells
attempt to destroy
the abnormal cells (self cure) and the clinical course and
complications depend on the balance. If the immune
mechanism is strong, there will be severe pancytopenia.
If not, there will be myelodysplasia.
25. Hematological findings: (Cont…)
Bone Marrow:
– Hypocellular:
<50% of normal cellularity Trephine biopsy is
the most important for diagnosis.
– Most of the cells present are lymphocytes,
plasma cells.
– Iron stores: increased
26. Treatment
Withdrawal of etiological agents.
Supportive.
Restoration of marrow activity:
– Bone marrow transplant
– Immunosuppressive treatment
- Prednisolone - Antilymphocyte glob.
- Cyclosporin - Anti T cells abs.
- Splenectomy
– Androgens
– Growth factors
27. Inherited Anemia
Fanconi’s Anemia:
The most common type of inherited aplastic anemias.
Associated with anomalies e.g., skeletal, skin.
Autosomal recessive.
Genetics:
Increased sensitivity of the cells to chromosomal damage
by DNA cross linking agents.
13 genes are responsible
IV54 mutation, is associated with multiple dysmorphism,
severe pancytopenia, higher incidence of AML.
28. Inherited Anemia
Clinical Features:
Skeletal and skin anomalies seen at birth
e.g., microcephally.
Manifestations of marrow failure, usually
later at age 5-10 yrs. Present as anemia,
mucusal bleeding e.g. nasal.
29. Clinical Features of Fanconi’s Anemia
Common Findings:
Low birth weight
Short stature
Microcephaly
Microphthalmia
Microstomia
Skeletal abnormalities, particularly of thumbs and radii
Generalized increased pigmentation of skin
30.
31.
32.
33. PURE RED CELL APLASIA
PURE RED CELL APLASIA
Pure red cell aplasia is characterized by a selective decrease in
erythroid precursor cells in the bone marrow. WBCs and platlets are
unaffected.
— Acquired
Transitory with viral or bacterial infections
Patients with hemolytic anemias may suddenly halt erythropoiesis
Patients with thymoma – T-cell mediated responses against bone
marrow erythroblasts or erythropoietin are sometimes produced.
— Congenital
Diamond-Blackfan syndrome – occurs in young children and is
progressive. It is probably due to an intrinsic or regulatory defect in the
committed erythroid stem cell.