The Treatment of Modern Western - Biblio.nhat-nam.ru

6APLASTIC ANEMIAAplastic or hypoplastic anemia refers to anemia due to failureof the bone marrow to produce blood cells. If severe, it is considereda medical emergency and may (rarely) require immediatehospitalization. However, in most patients, AA is discoveredduring routine screenings. Fifty to 75% of all cases oftrue aplastic anemia are idiopathic. It is currently suspectedthat idiopathic aplastic anemia is an autoimmune disease.Recognized causes of aplastic anemia include chemicals, suchas benzene, toluene, and DDT, radiation, and drugs, such asantibiotics, NSAIDs, anticonvulsants, and antineoplastics.Some cases are caused by viral infection, principally viral hepatitis,although Epstein Barr virus has also been implicated ina lesser number of cases. In addition, there seems to be agenetic predisposition to this disease. While some sources saythat males are more prone to this disease than females, otherssay its incidence is equal between males and females. Its incidenceis also said to increase with age.The onset of aplastic anemia tends to be insidious, though itoccasionally may be acute. The three main clinical characteristicsof this disease are: 1) weakness and fatigue, 2) fever, and3) petechiae and bleeding. General symptoms of anemia areusually severe, such as waxy pallor of the skin and mucousmembranes. Chronic cases may show considerable brownskin pigmentation. Severe thrombocytopenia may occurwith bleeding into the skin. However, thrombocytopenicpurpura is dealt with separately in the following chapter. Interms of blood analysis, RBCs are normochromic-normocytic,WBC counts are equal to or less than 1500/mm 3 .Platelets are often markedly reduced. Reticulocytes aredecreased or absent, and aspirated bone marrow is acellular.The Western medical treatment of aplastic anemia consistsof intravenous infusion of immunosuppressive agents, suchas equine antithymocyte globulin (ATG) and antilymphocyteglobulin (ALG), over 4-6 hours for 10 consecutivedays. This is effective in approximately 60% of patients.However, because ATG is a biologic product, allergic reactionsand serum sickness may occur. Therefore, all patientsreceiving this therapy are given concomitant corticosteroids.Cyclosporine is as effective as ATG and has gotten a positiveresponse in 50% of ATG failures. This has led to somephysicians to prescribe joint ATG and cyclosporine therapy.Patients unresponsive to ATG or cyclosporine may respondto treatment with cytokines. Other medications in currentuse and under investigation include hemopoetic growth factors,colony stimulating factors, interleukin-3, and androgens.In severe cases of aplastic anemia, bone marrow transplantationfrom an identical twin or HLA-compatible siblinghas proven successful, particularly in patients under 30years of age. Because transfusions pose a risk to subsequenttransplantation, blood products are used only when essential.When used, these consist of platelet transfusion. Therisk of developing subsequent malignancy after treatmentfor aplastic anemia is 5.5 times greater than in healthy individuals.CHINESE DISEASE CATEGORIZATION: The chronicform of this disease is traditionally classified as xu lao, vacuitytaxation, xue xu, bood vacuity, wang xue, blood collapse, andxu ku, blood dessication. The acute form of this disease is traditionallyclassified as xue zheng, bleeding condition, wen re,warm heat, ji lao, acute taxation, and re lao, heat taxation.DISEASE CAUSES: Former heaven insufficiency, latterheaven lack of nourishment, external contraction of the sixenvironmental excesses, unregulated eating and drinking,internal damage by the seven affects, enduring disease, andbedroom taxationDISEASE MECHANISMS: The disease mechanisms ofaplastic anemia are categorized as consisting of a root vacuitywith branch repletions. Of these, the root vacuity is the moreimportant. Another way of saying this is that there is a right-