I. What is aplastic anemia? What is the difference between “acute aplastic anemia” and “chronic aplastic anemia”?
Aplastic anemia (abbreviated as reblastosis) is a group of diseases caused by chemical, physical and biological factors and unexplained damage to the bone marrow stem cells or/and hematopoietic microenvironment, resulting in centripetal atrophy of the red marrow, which is replaced by adipose tissue and a decrease in the number of whole blood cells (neutrophils, red blood cells and platelets) in the blood. There were no tumor cells in the bone marrow and no reticulofibrillary hyperplasia. There are two types of remittent disease: acute remittent disease and chronic remittent disease, but in clinical practice, chronic remittent disease is generally more common. The difference between the two mainly lies in the speed of disease progression, severity of the disease and the severity of concurrent infections and bleeding, and bone marrow changes. The symptoms of chronic reoccurrence are mild and non-heavy reoccurrence; the blood picture of acute reoccurrence shows a progressive and rapid decline, which is very difficult to treat, and many patients die due to serious infection and intracranial hemorrhage. However, heavy reoccurrence and non-heavy reoccurrence are not distinctly separated, and the two can be transformed into each other. After acute heavy reoccurrence is controlled by active treatment, the blood/myelogram index may show chronic non-heavy reoccurrence; while chronic non-heavy reoccurrence patients with acute reoccurrence symptoms due to infection and improper drug use are called heavy reoccurrence type II and need to be treated as acute heavy reoccurrence.
Second, which middle-aged and elderly people should be alert to the occurrence of aplastic anemia?
There are many factors that can cause aplastic anemia in middle-aged and elderly people, and the factors related to the disease are mainly as follows.
1.Drug factors
The use of many drugs can directly or indirectly inhibit the hematopoietic function of bone marrow, among which chloramphenicol is common, mostly occurring in the weeks or months after taking. For patients with neoplastic underlying diseases, the myelosuppressive effect of chemotherapy drugs is the main reason. Among them, the inhibitory effects of cytarabine and methotrexate are reversible, while leucovorin and nitrosamines are permanent.
2.Chemical poisoning
Chronic benzene poisoning is common. It can be caused by the pollution of benzene-containing waste from surrounding factories, or excessive benzene residue in newly decorated furniture.
3.Viral infection
Hepatitis B virus is the most common. Acute reoccurrence occurs more often after 10 weeks of recovery from hepatitis B. Chronic reoccurrence also has a good correlation with the history of chronic hepatitis B.
4.Immune factors
Recurrent cataract can also be secondary to autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. People with the above-mentioned medical history should be alerted when they have decreased erythrocyte, neutrophil and platelet counts in routine blood tests.
Third, what manifestations should we suspect the possibility of aplastic anemia?
Aplastic anemia is different from general anemia in that in addition to a decrease in hematocrit, there is also a decrease in white blood cells and platelets. In this regard, it is important not to be careless when the following symptoms appear.
1.Anemia symptoms
Dizziness and weakness, pale face, pale lips and nails.
2. Bleeding symptoms
The symptoms include repeated nosebleeds, bleeding gums, and bleeding spots or ochreous patches on the skin of the body; in the case of women, the amount of menstruation may increase compared with the previous period, and the period may be prolonged; some patients may have abdominal pain and tarry colored stools, which are caused by intestinal bleeding.
3.Symptoms of infection
Most patients will have unexplained recurrent low-grade fever, usually for a longer period of time; severe life-threatening infections, such as severe sepsis, often manifesting as mental abnormalities, require prompt access to a hospital for active resuscitation. When at least two of the above three major symptoms appear, you should be alert and go to the hospital promptly.
Fourth, what are the necessary tests that should be done if I suspect I have the disease?
In the diagnosis of reoccurrence, routine blood test is the simplest and most direct basis, which generally shows the decrease of blood triple system (hematocrit, platelet, neutrophil). When a neutrophil count <0.5< span="">×109/L, platelets <20< span="">×109/L, and reticulocytes <1% are present, it is indicative of possible acute reocclusion, as chronic reocclusion has a relatively mild degree of decline. It should be noted that there is a specific type of cell count alteration in reoccurrence, e.g., the blood count only shows a decrease in red blood cells, but the platelet count, white blood cell count, or < span="">neutrophils are still normal, so if the diagnosis of pure red blood cell reoccurrence is suspected, further bone marrow examination is needed to clarify the bone marrow proliferation. The proportion of non-hematopoietic cells (e.g. lymphocytes, adipocytes) is significantly higher. When other diseases that may cause trilineage reduction are excluded, such as systemic lupus erythematosus, tuberculosis, etc., the diagnosis can be clarified by combining clinical examination and medical history.
V. Is oral iron supplementation useful for the treatment of aplastic anemia?
Many people have the misconception that anaemia can be treated by drinking blood supplements. However, most of the general health supplements contain iron supplements, which are suitable for iron deficiency anemia, but are often counterproductive for aplastic anemia. First of all, patients with reblindness do not have iron deficiency in their bodies, but most of them have decreased iron utilization capacity of bone marrow red blood cells, which leads to iron overload in their bodies. On the other hand, many patients rely on blood transfusion and need repeated transfusions to maintain their treatment, so it is more likely to cause iron accumulation in the body. If the patient takes iron supplements for a long time, the condition will be aggravated. The iron overload in patients with rechondroplasia will affect the dysfunction of heart, liver, kidney and other organs, and even complicate hemochromatosis, leading to liver cirrhosis, diabetes, skin pigmentation, endocrine disorders, heart and joint lesions and other life-threatening pathologies, so it is necessary to go to a specialized hospital for regular iron removal treatment as soon as possible.
Sixth, why do patients with remittance find themselves with masculine signs after treatment? Is it serious?
Androgens are the most commonly used first-line drugs in the treatment of chronic reoccurrence. Most female patients will have masculine signs after a period of treatment, which is related to the application of this drug. Since the essence of reoccurrence is bone marrow hematopoietic failure, it is especially necessary to use various means such as injections or oral administration of androgens to stimulate the recovery of bone marrow hematopoietic function, so that patients can maintain a certain degree of normal blood picture. However, androgens are male sex hormones, and after a period of treatment, women will have thicker voices, facial acne, thicker hair growth on the limbs, reduced menstrual flow, and weakened libido, while men will have more masculine features and even a high libido. Many patients are concerned about this, especially women who do not want to take it. However, it should be noted that once androgens are stopped, the above symptoms will gradually improve or even disappear.
What are the special methods to treat aplastic anemia?
Aplastic anemia is a refractory hematologic disease and there is no absolute cure. Western medicine conventional treatment includes: androgens, immunosuppressants, hematopoietic factors, allogeneic bone marrow transplantation, high-dose methylprednisolone, high-dose gammaglobulin, splenectomy, etc. Due to the critical condition of acute reoccurrence, patients aged 20-40 years should first consider choosing HLA all-compatible allogeneic hematopoietic stem cell transplantation, which has a high cure rate but needs to consider the cost and certain degree of risk. In acute reoccurrence in other age groups, anti-thymocyte globulin (ATG) and anti-lymphocyte globulin (ALG) combined with androgens, cyclosporine, hematopoietic factors and Chinese herbal medicine are often used.
What are the most important side effects to be noted in the process of cyclosporine treatment?
The application of cyclosporine is of great significance in the treatment of reoccurrence, especially in the treatment of chronic reoccurrence. It can regulate the over-activated immune status in patients, reshape the balance and restore the hematopoietic function to a certain extent. However, cyclosporine has more side effects, and some patients may develop liver and kidney function impairment, hirsutism, gastrointestinal reactions (nausea, vomiting), gingival hyperplasia, etc., and among them, liver function impairment is more common. In this regard, when cyclosporine is given to patients clinically, it should be accompanied by liver protection drugs in particular. Patients should also follow medical advice to strengthen liver protection treatment, and if liver function indicators are repeatedly abnormal, the drug must be changed under the guidance of a hematologist. Once the drugs are stopped by themselves, it may further aggravate the disease and make the treatment more difficult.
Is blood transfusion an effective method for treating aplastic anemia?
Blood transfusion is an essential tool in the treatment of many patients with aplastic anemia, and it can improve the anemia symptoms in the shortest possible time. On the one hand, blood transfusion still has the possibility of disease transmission, and many patients will have transfusion reactions (including cold sweats, fever, jaundice, etc.) or even life-threatening; on the other hand, too frequent and excessive blood transfusion will lead to iron overload and corresponding complications. Therefore, the indications for the selection of blood transfusion must be mastered. From the test index, generally in hemoglobin <80g/L, platelets <20<
span=””>×109/L before considering transfusion of the appropriate red blood cells or platelets. And in combination with the symptoms, patients with obvious bleeding, dizziness and severe weakness should be appropriately transfused even if the index does not meet the requirements, but should not be abused.
X. Why do patients with aplastic anemia have poor resistance and easily catch a cold?
Due to the immune insufficiency of patients with aplastic anemia, their resistance is significantly reduced and their neutrophil count is much lower than normal, so they are prone to colds and colds are difficult to be cured,
Repeated colds often aggravate the disease. Therefore, if you find that you have had repeated colds in recent years with poor treatment results, you should go to the hospital for examination to exclude blood system diseases. For patients who have been diagnosed with reoccurring disorders, they should pay attention to cold and warmth, improve personal hygiene, and minimize the occurrence of colds and infections in the daily care process. Because these conditions can make the disease repeated and further aggravated, and even let the chronic reoccurrence into heavy reoccurrence type II, threatening the patient’s life.
Eleven, can aplastic anemia be cured?
The current view is that hematopoietic stem cell transplantation is the only effective means to cure acute reoccurrence. However, there are limitations of this method in its conditions, such as: high cost, difficulty in matching, age requirement, and difficulty in finding related HLA all-matched donors. Transplantation is generally considered only for patients with acute reangiogenesis aged 20-40 years, and the younger the patient, the higher the probability of successful transplantation. In contrast, middle-aged and elderly patients are relatively more troublesome and are more obviously affected by various aspects of physical quality, which is generally not advocated, but there are reports of successful transplantation in middle-aged and elderly patients, depending on a comprehensive analysis.
XII. Is Chinese herbal medicine treatment effective?
In Chinese medicine, there is no disease name for re-injury, but it is often classified as “medullary labor”, “deficiency labor”, “blood evidence”, “acute labor” and so on according to its performance. It is often classified as “medullary labor”, “deficiency labor”, “blood evidence”, “acute labor”, etc. According to the theory of Chinese medicine, this disease is caused by the patient’s congenital deficiency of essence and loss of nourishment, which leads to the entry of external evil and toxic gases into the blood and marrow, thus affecting the blood production function. Therefore, for acute reoccurrence, the main treatment is to clear the heat and detoxify the toxin, taking into account nourishing Yin and water; while for chronic reoccurrence, the main treatment is from the kidney, specifically the kidney Yang, nourishing the kidney Yin and strengthening the spleen. Among them, the advantages of TCM treatment for chronic reoccurrence are more significant, and many patients can even maintain stable disease under the evidence-based treatment of TCM alone. In addition, patients with chronic reoccurrence can also use herbal remedies to nourish blood (such as angelica and ginseng) and food therapy to improve resistance and reduce recurrence of the disease.
Points to note for TCM treatment:
1. Clinically, patients with reoccurrence are critical and complicated. The key to successful treatment is accurate diagnosis and treatment;
2. Early treatment, fractional treatment and combination of drugs are the key to improve the efficacy;
3.The treatment of reoccurrence must be persistent (half year, one year or even several years) and maintenance treatment for more than 2 years;
4.Prevent infection, strengthen nutrition, and improve the immune function of the body. If there is any change in the condition of the disease, promptly consult the doctor and give support and symptomatic treatment.