A 10-year Retrospective Of Aplastic Anemia In Hospitalized Children

Objective:1. To investigate the epidemiology features of hospitalized children.2.Evaluate the efficacy of different types of aplastic anemia in children adopted by different treatment, compared with the same period domestic data,to seek more appropriate treatment options.3. Learning a large number of medical articles, get the summary of pathogenesis of aplastic anemia.Methods: 1.Get the total number of cases of aplastic anemia in hospitalized Children in ten years.(between1999.3-2009.3).2.Using retrospect- tive analysis method describe characteristic of gender and age and course of disease , inhabited environment , clinical situation, hemogram and bone marrow picture of aplastic anemia in hospitalized children. Evaluate the efficacy of different types of aplastic anemia in children adopted by different treatment, compared with the same period domestic data to seek more appropriate treatment options.2.To search a lot of databases,take CNKI, PubMed and CBM for example,find lots of medical articles on the pathogenesis of aplastic anemia in the past 10 years.Results: 1. 122 cases of aplastic anemia was treatd in the SecondHospital of Hebei Medical University in past ten years (between1999.3-2009.3).3 cases was lost, 97(81.5%)children lived in rural areas,others(18.5%) lived in city. Male:72 cases,Female:47cases,male/female is 1.53/1. Age:from 6 months to 14 years. median age was 7.5 years .Course of disease:from 1 day to 3 years.Severe aplastic anemia( SAA):30 cases,Severe aplastic anemia-Ⅰ(SAA-Ⅰ)11case,Severe aplastic anemia-Ⅱ( SAA-Ⅱ)19 cases ;Chronic aplastic anemia( CAA)89 cases.2. We did not found multiple abnormalities or white coffee maculae or chromatosis with 119cases of aplastic anemia children through physical examination.Based on excluding congenital aplastic anemia,we get the message of history of past illness , family history , inhabited environment ,and whether getting in touch with baneful chemicals and physical factors or not , at the same time consummating screening of hepatitis and viruses and so on. 2 cases were infected by HBV,so the 2 cases were diagnosed with hepatitis associated aplastic anemia.While the other aplastic anemia children were not founded definite exciting cause, so were diagnosed with idiopathic aplastic anemia. 3. The diagnosis of aplastic anemia depended on clinical manifestation and hemogram and bone marrow picture, part of the bone marrow in children with atypical,can be further done to confirm the diagnosis of bone marrow biopsy.4. Clinical manifestation: Skin and mucous membrane bleeding:42 cases ( 35.2% ) , rhinorrhagia :27 cases (22.6% ) , gingival bleeding :13 cases (10.9% ) , hypermenorrhea: 4 cases ( 3.36% ), simple or accompanied by acratia or pale face or Dizziness : 45 cases (37.8% ). Having a fever or respiratory infection symptoms :29 cases(24.4%). Other clinical manifestations:alimentary tract hemorrhage :2 cases,headache and intracranial hemorrhages: 2 cases,Subdural hematoma: 1 case,accompanied by pulmonary hemorrhage and cellulitis: 1 case。5. Changes in blood:There were 119 cases of children with varying degrees of anemia,hemoglobin (Hb) < 30 g/ L :9 cases,30-60 g/ L :41 cases,60-90 g/ L: 53 cases,90-120 g/ L :16cases;blood platelets (plt): < 20×109/ L 53 cases;reticulocyte coun < 1 % 27 cases;neutrophilic granulocyte < 0.5×109/L: 29 cases,in 30 cases of severe aplastic anemia in children, neutrophilic granulocyte < 0.5×109/L: 27 cases, plt: < 20×109/ L 29 cases,reticulocyte count < 1 % 25 cases。6.In 89 cases of chronic aplastic anemia in children,there are 31 cases treated With androgen and compound Zaofan Pill effective power is 67.8%;there are 58 cases treated With ciclosporin, effective power is 75.9%;Severe aplastic anemia children were 30 cases, 1 cases was treated with antithymocyte globulin (ATG), effective power was poor.Others were treated with immunosuppressant,13 cases were treatment with ciclosporin and Gamma globulin , effective power was 53.9%;16 cases were treatment with ciclosporin and Gamma globulin and hormone,effective power was 56.3%.Conclusions: 1. Men in all children with aplastic anemia were more than women,men/women is 1.53/1; Chronic aplastic anemia was more than severe aplastic anemia; Children in rural areas were more than children in urban; Acquired aplastic anemia had a high incidence compared with congenital aplastic anemia. 2.Timely diagnosis and timely treatment for Aplastic anemia is very important,AA diagnosis, relying on sternal bone marrow puncture or a single site could easily lead to misdiagnosis ,so bone marrow puncture site should be noted,when necessary to do bone marrow biopsy at the same time together with some immunological methods。3. Immunosuppressant treatment of aplastic anemia have a positive effect. Cyclosporine and androgen and compound-made alum pill have a good efficacy in the treatment of chronic aplastic anemia;ALG / ATG combined with cyclosporine have a good effect in treatment of severe aplastic anemia. 4. Immune mediated plays a major role in the pathogenesis of Aplastic anemia, there are abnormalities in Cell-mediated immunity and humoral immune and the level of a regulator of hematopoietic and gene.