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APLASTIK ANEMIA

Aplasia of bone marrow:
quantity or function :
Hemopoietic tissue (blood forming-elements)
 decrease  activity of bone marrow 
 adult blood cell forming 

anemia .leucopenia .thrombocytopenia  By various causes .Aplastik anemia  pancytopenia Pancytopenia: All of hemopoetic cells system  .

PATOFISIOLOGI Basic disorder: disturbance/damage of: 1. Plurypotent stem cell : .Inhibition substance of growth cell  bone marrow tissue unable to growth and develop .Abnormality of humoral factor .quantity & function decrease  proliferation & differentiation  2. Microenvironment (marrow environment): .Microvaskular disorder .

Radiation 4. Chemical 3.structure: hydrocarbon – benzene .CAUSE FACTOR : I. Drugs 2. Drugs .dose & duration of consumption . Infection 5.individual susceptible . Primary/Idiopathic  50% II. Constitutional/familial 1. Secondary: 1.

Sometimes depress bone marrow: .Cytostatic b.Muscle relaxant : meprobamate 2. skin contact & oral (accident)  insecticide.Anticonvulsant: methylhidantoin .Antibiotic: chloramfenikol. sulfonamide ect . ect . Often/always depress bone marrow: . Chemical .inhalation.Drugs  bone marrow depression: a. organic dilution.Analgesic: Phenylbutasone .

stem cell  critical period 3-6 week . Infection .gonad germinal cell . Constitutional /familial/ congenital  Fanconi Syndrome .3.cause agent  stem cell 5.stem cell environment  capillary 4.immunologic mechanism . Radiation  fast growth tissue: .epithel of intestine Radiation cause damage of: .hemopoesis tissue .

000/mm3: cerebral and gastrointestinal bleeding  prolonged bleeding time No RES organ enlargement .thrombocytopenia: bleeding <50.anemia  general symptoms of anemia . Clinical symptoms  Pancytopenia (important sign): .granulocytopenia: easy to get infection .MANIFESTATION/SIMPTOMS The onset usually gradually 1.000/mm3: spontaneous bleeding <20.

many adipose tissue Bone marrow puncture is very important ! .relative lymphocytosis 3.2.hypocellular (bone marrow aplasia)  relative frequently: lymphoid cell& reticulum .normochrome normocytic anemia .000-100.low reticulocyte (normal: 50. Peripheral blood: .000/mm3) . Bone marrow: .

Fe serum DIFFERENTIAL DIAGNOSIS 1. ITP and ATP 2.5. Hb F can increased 6. Leukemia  aleukemic pancytopenia reticulocytopeni relative lymphocytosis Blast cell or lymphocytosis > 90 %  ALL .

Avoid infection .9 g/dl  .Bone marrow stimulation (hemopoesis)  androgen hormone: testosterone & oximetolone . trombocyte & granulocyte suspension .fraction: PRC.Avoid trauma  mucosa & skin .TREATMENT Principal of treatment: .Blood transfusion: as minimum as possible  Hb 8 .Remove the causes .

Replacement the damage stem cell  bone marrow transplantation ..Other treatment: Corticosteroid  severe thrombocytopenia Splenectomi  resistance cases Immunosuppressive agent  immunological cause .

PROGNOSIS .Bleeding .acellular .Bone marrow picture .HbF concentration  >200 mg%: good prognosis .Infection Cause of death: .hypocellular .Granulocyte:  > 2000/mm3: good prognosis .Age .Infection .