Course title: Hematology (1)Course code: MLHE-201 Supervisor: Prof. Dr Magda Sultan

Outcome: The student will know:

-The causes and pathogenesis of aplastic anemia.

-The diagnosis of aplastic anemia . -The laboratory tests needed for diagnosis

Aplastic Anaemia

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APLASTIC ANEMIA

• Aplastic anemia is a severe, life threatening syndrome in which production of erythrocytes, WBCs, and platlets has failed.

• Aplastic anemia may occur in all age groups and both genders.

• The disease is characterized by peripheral pancytopenia and accompanied by a hypocellular bone marrow.

Definition of aplastic anaemia.• Peripheral blood pancytopenia and a

hypocellular marrow in which normal marrow is replaced by fat cells.

• Abnormal cells are not found.

Normal Haemopoiesis.• Red cell life span 120 days.• Platelet life span 6 days.• Granulocyte life span < 24 hours.• Constant marrow activity needed to replace

dead cells.

Pathogenesis.• Primary defect or damage to haematopoietic

stem cell.• possible Immunological attack on stem cells. .• Defective microenvironment (i.e. marrow

stromal defect)

Haematopoietic stem cell.

Pathophysiology of aplastic anemia

Aetiology.(Causes )• INHERITED(20%)o Fanconi Anaemiao Dyskeratosis congenitao Shwachman-Diamond

syndromeo Diamond-Blackfan anaemia.

• ACQUIRED(80%)o Idiopathico Drug inducedo Viral (hepatitis, EBV)o Ionising radiationo Toxins (pesticides,

benzene, arsenic)o Pregnancy o leukaemic

Clinical Features.• Anaemia; tiredness & fatigue, palpitations .

• Low white count; recurrent infections .

• Low platelets; easy bruising and bleeding.

Investigations.• CBC ( Hb < 10 g /dl , TLC < 4000 /cmm ,

platelets < 100,000 /cmm )• Reticulocyte count ( decreased )• Blood film.• B12/folate.• Liver function tests• Virology• Bone marrow aspirate & trephine

APLASTIC ANEMIA

–Lab findings»Severe pancytopenia with relative

lymphocytosis (lymphocytes live a long time)»Normochromic, normocytic RBCs »Mild to moderate anisocytosis and

poikilocytosis»Decreased reticulocyte count»Hypocellular bone marrow with > 70% yellow

marrow

Severe Aplastic Anaemia

• Peripheral Blood o Granulocytes <0.5 x 109/lo Platelets <20 x 109/lo Reticulocytes <1%• Marrow trephine• Markedly hypocellular <25% normal

Marrow trephine

HYPOCELLULAR BONE MARROW IN APLASTIC ANEMIA

OTHER HYPOPROLIFERATIVE ANEMIAS

• Renal disease – due to decreased erythropoietin

• Endocrine deficiencies – may lead to decreased erythropoietin production. For example: hypothyroidism leads to decreased demand for oxygen from tissues; decreased androgens in males; decreased pituitary function

Assignement: Topic Student Names

Acquired aplastic anaemia عشري محمد حماده

Training questions :

What are the laboratory findings in aplastic anaemia ?

How to diagnose Aplastic anaemia ?

• Reference book :• Essential Hematology .• Dacie .