Treatment of aplastic anemia (anemotrophy) in Germany

Aplastic anemia is characterized by the oppressed process of blood corpuscle production (white blood cells, platelets,and  red blood cells) in the bone marrow. This pathology is a rare one.


Its incidence in Western countries is 3-5 cases per million of population a year. Asia has the highest incidence which is up to 15 cases per million of population a year.


Aplastic anemia


Causes of Aplastic anemia (Anemotrophy)

There are congenital and acquired forms of aplastic anemia. Congenital forms are characterized by defects in stem cell development and as a result the hematopoiesis (blood cell maturation) disorders appear.


Congenital forms of aplastic anemia are:

  • Dameshek’s anemia (without congenital anomalies of development)
  • Fanconi's anemia (development anomalies are present)
  • Diamond-Blackfan syndrome (DBA) is rare with the selective affection of erythropoiesis – maturation of red blood cells


Acquired aplastic anemia can occur because of a number of reasons:

  • After the administration of certain medicines (carbamazepine, chloramphenicol, metamizole sodium, cytostatics, indomethacin)
  • Due to poisoning with toxins (benzene, salt of heavy metals)
  • Infection (viral hepatitis)
  • Systemic diseases of connective tissues (lupus erythematosus, Sjögren's syndrome)


In the majority of cases, it’s impossible to establish the cause of the pathology. In such case it is calledidiopathic (unknown origin) acquired aplastic anemia.


Aplastic anemia symptoms


Symptoms of Aplastic anemia (Anemotrophy)

The clinical course of aplastic anemia is manifested by three syndromes:

  • Anemic
  • Hemorrhagic
  • Infectiousandinflammatory


Anemic syndrome appears the first and it is associated with the abnormalities of red cells formation in the bone marrow.


Patients with anemia complain about:

  • Fatigue
  • Noise in the ears
  • Feeling unwell in enclosed spaces
  • Weakness


While examination, the pallor skin covering can be noted. Blood flow insufficiency can result in an enlarged liver and swelling in the legs. Heart rate is increased while resting.


Hemorrhagic syndrome is manifested by petechial skin rash. Patients complain about large bruises after minor injuries. Nasal, uterine, and gastrointestinal bleedings can occur.

Infectious and inflammatory syndrome is rare often with bacterial infections. Pneumonia, boils, and abscesses may also develop while having this syndrome.


Aplastic anemia diagnostics


Aplastic anemia (Anemotrophy) - Diagnostics

Diagnosis of aplastic anemia is determined by blood test and a biopsy of the iliac bone. Trepan-biopsy material will reveal the yellow marrow prevalence above the red one.


Diagnosis is done based on the following blood test results:

  • Normocytic anemia (red blood cells size stays within the normal range while their overall quantity is decreased)
  • MCV is ranges from 80 up to 100 (it’s an indicator that is received by division of hematocrit on the red blood cells quantity)
  • Hypoplastic anemia (reticulocytes are below 1%)
  • Granulocytopaenia (reduction of polymorphonucleocytes in the blood; these cells are one of the white blood cell types)
  • Thrombocytopenia (low level of platelets in the blood)


According to clinical course there are:

  • Aplastic anemia
  • Severe aplastic anemia
  • Super severe aplastic anemia


Criteria for diagnosis of severe aplastic anemia are:

  • Level of polymorphonucleocytes in the peripheral blood is lower than 0,5?109/l
  • Level of reticulocytes is below 20X109/l
  • Platelet concentration is below 20X109/l
  • Hypo cellular(according to the biopsy results)


Super severe aplastic anemia is diagnosed when polymorphonucleocytes level in the peripheral blood drops below 0,2X109/L.


Aplastic anemia treatment abroad


Treatment of Aplastic anemia (Anemotrophy) abroad

Main goal of the treatment is to reach remission period of aplastic anemia. For some of the patients it’s possible to do it with the help of immunosuppressivetherapy.


Other patients can be treated only with the help of stem cells transplantation. Second aim of the treatment is to normalize blood indicators to block the symptoms of the disease.


Main directions in aplastic anemia treatment are:

  • Immunosuppressive therapy. Doctors prescribe such drugs as cyclosporin A, cytostatics, anti-thymocyte immunoglobulin. A number of patients are indicated the surgical removal of the spleen. Immunosuppressive therapy is ineffective for severe and super severe aplastic anemia treatment.
  • Symptomatic treatment is aimed at the compensation of hematopoietic insufficiency and to defeat the consequences of the illness. A patient has to undergo the intravenous infusion of packed red cells and platelet for relief of anemic and hemorrhagic syndrome. Antibacterial treatment is applied if there is an infectious process in the body.
  • Stem cells transplantation is the only way of aplastic anemia treatment that allows reaching permanent clinical improvement.Stem cells are taken from a donor. They take them either from his bone marrow or from his peripheral blood. After that, in case of success, there comes a stable remission of the disease.


Aplastic anemia prognosis


Aplastic anemia (Anemotrophy) - Prognosis

If left untreated, there is nothing good for the patient to wait. People die within several months as a result of bleeding or because of infectious complications.


Immunosuppressive therapy can give remission period to the patient with aplastic anemia in 50-70% of cases, though 30% of them will experience the recurrence of the illness. 30-50% of such patients might have myelodysplastic syndromes that are peculiar with hematopoietic (blood formation) inefficiency.


Two-year survival rate of those who underwent symptomatic therapy (if immunosuppressive therapy wasn’t performed or appeared to be inefficient) does not go over 20%.

Best and most effective method of treatment is allogeneic stem cell transplantation. It allows a patient to recover in 70-90% of cases.


Prognosis depends on a number of factors such as: age of patient, the content of reticulocytes in peripheral blood, aplastic anemia severity, presence of concomitant diseases. Low percentage of stem cells transplantation failure is associated with the reaction “graft versus host”.



Max Grundig Clinic Buehl

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