The common of all known cause of Aplastic anemia is exposure to drugs or environmental toxins. Benzene was the first known toxin to cause bone marrow failure. Despite this it is still widely used in industry in the manufacture of drugs, dyes, explosives and other chemicals. Exposure should be limited to 1 part per million, but this is often exceeded, especially in developing countries. Other related organic chemicals also cause Aplastic anemia, including:
- toluene (in glues)
- the insecticides DDT and lindane
- the explosive TNT
- the wood preservative PCP
- petroleum distillates.
Drugs that cause Aplastic anemia may also be related to benzene. The antibiotic, chloramphenicol and the anti-inflammatory, phenylbutazone are two examples. Neither is commonly used in Western countries, but because they are cheap to produce, they are in widespread use in the developing world. Other medicines with a moderate risk of Aplastic anemia include gold salts and penicillamine, used to treat arthritis, carbamazepine and phenytoin, used to treat epilepsy, and the diuretic acetazolamide.
A large number of drugs have been associated with occasional cases of Aplastic anemia. Most of these are useful drugs and cannot easily be replaced other then turning to herbal medicine. Herbal medicine with much less side effects is strongly recommended.
Radiotherapy (treatment with X-rays) suppresses the bone marrow, and may be intentionally used to do so in preparation for bone marrow transplantation. The use of these treatments should be confined to specialized centre where careful monitoring of the blood count takes place.
Some cases of Aplastic anemia have occurred after viral infections. In particular, hepatitis A, hepatitis B and 'non-A, non-B, non-C' hepatitis have been implicated, and more rarely the Epstein-Barr virus.
Very rarely Aplastic anemia occurs during pregnancy. It is not clear whether this is just a coincidence. Sometimes the disease recovers spontaneously at the end of pregnancy.
Symptoms
Patients complain of increasing tiredness, weakness and shortness of breath. Bleeding, bruising and blood spots may be noticed. Sore throats and other infections are noticeable. A high temperature with shivering attacks is an important symptom that demands immediate medical attention.
Aplastic anemia diagnosis
The following combination of three symptoms should raise suspicion of bone marrow failure:
Anemia - tiredness, weakness and breathlessness low white cell count in the blood (neutropenia) - fever, sore throat, shivering attacks
low platelet count (thrombocytopenia) - bruising and bleeding.
When you see pale skin it is possible sign of heart failure, bruises and petechiae (small blood spots in the skin and mouth), mouth ulcers and fever. The back of the eye is likely to see small haemorrhages on the retina.
An important negative finding is the absence of enlarged lymph nodes or an enlarged spleen. Their presence would point to other diagnoses, such as lymphoma or leukemia.
The most important test is the full blood count, which will show reduced numbers of red cells, white cells (neutropenia) and platelets (thrombocytopenia) - in other words all of the cellular components of blood. This feature is called pancytopenia.
The level of the neutrophil count defines the severity of the disease. Neutrophils are normally the most numerous of the various types of white cell we have in our blood and they are particularly involved in combating infection by bacteria and fungi.
- Counts below 0.5 x 109/L mean severe Aplastic anemia.
- Counts below 0.2 x 109/L mean very severe Aplastic anemia.
The most important distinction that the hematologist must make is between Aplastic anemia and acute leukemia, which can show very similar blood pictures. For this reason a bone marrow sample is essential. The doctor will take samples both of the fluid of the bone marrow (an aspirate) and of the more solid bone marrow structure (a trephine biopsy). For most cases the diagnosis is easily made. In acute leukemia the marrow is full of abnormal cells but in Aplastic anemia it is empty and comprises mainly fat spaces.
MALAYSIA MASTERTOLE'S way of treatment has shown very positive result in treating and controlling these conditions. At present time we have been doing a lot of research on this sickness. |
