Skip to main content

Acquired Aplastic Anemia: Classification and Etiologic Considerations

  • Chapter
Book cover Aplastic Anemia and Other Bone Marrow Failure Syndromes

Abstract

Acquired aplastic anemia is an anatomic and physiologic failure of the bone marrow leading to pancytopenia. While occasionally the pancytopenia may be associated with a normocellular bone marrow, in the vast majority of the cases, the bone marrow is hypoplastic and pancytopenia is pronounced. The aplastic anemia is referred to as severe when, in addition to a hypoplastic bone marrow (less than 25% cellularity), at least two of the following three conditions are present: polymorphonuclear leukocyte count <500/µl, platelet count <20 X 103/µl, and anemia with a reticulocyte count (corrected for hematocrit) of less than 1%.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Szklo M, Sensenbrenner L, Markowitz M, et al. Incidence of aplastic anemia in metropolitan Baltimore: A population-based study. Blood 1985; 66:115–119.

    PubMed  CAS  Google Scholar 

  2. Bottiger LE, Westerholm B. Aplastic anaemia: I. Incidence and aetiology. Acta Med Scand 1972; 192:315–318.

    Article  CAS  Google Scholar 

  3. Bottiger LE. Prevalence and etiology of aplastic anemia in Sweden. In: Hibino S, Takaku F, Shahidi NT, eds. Aplastic Anemia. Baltimore: University Park Press, 1978: p. 171–180.

    Google Scholar 

  4. Whang KS. Aplastic anemia in Korea: A clinical study of 309 cases. In: Hibino S, Takaku F, Shahidi NT, eds. Aplastic Anemia. Baltimore: University Park Press, 1978: pp. 225–242.

    Google Scholar 

  5. Aoki K, Ohtani M, Shimizu H. Epidemiological approach to the etiology of aplastic anemia. In: Hibino S, Takaku F, Shahidi NT, eds. Aplastic Anemia. Baltimore: University Park Press, 1978: pp. 155–170.

    Google Scholar 

  6. Alter BP, Potter NU, Li FP. Classification and aetiology of the aplastic anaemias. Clin Haematol 1978; 7:431–465.

    PubMed  CAS  Google Scholar 

  7. Smick KM, Condit PK, Proctor RL, et al. Fatal aplastic anemia: An epidemiological study of its relationship to the drug chloramphenicol. J Chron Dis 1964; 17:899–914.

    Article  PubMed  CAS  Google Scholar 

  8. Yunis AA. Chloramphenicol-induced bone marrow suppression. Seminars Hematol 1973; 10:225–234.

    CAS  Google Scholar 

  9. Wallerstein RO, Condit PK, Kasper CK, et al. Statewide study of chloramphenicol therapy and fatal aplastic anemia. JAMA 1969; 208:2045–2050.

    Article  PubMed  CAS  Google Scholar 

  10. Fraunfelder FT, Bagby GC, Jr., Kelly DJ. Fatal aplastic anemia following topical administration of ophthalmic chloramphenicol. Am J Ophthalmol 1982; 93:356–360.

    PubMed  CAS  Google Scholar 

  11. Abrams SM, Degman TJ, Vinciguerra V. Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Intern Med 1980; 140:576–577.

    Article  PubMed  CAS  Google Scholar 

  12. Frauenfelder FT, Bagby GC. Ocular chloramphenicol and aplastic anemia [letter]. N Engl J Med 1983; 308:1536.

    Google Scholar 

  13. Farber BF, Brody JP. Rapid development of aplastic anemia after intravenous chloramphenicol and Cimetidine therapy. South Med J 1981; 74:1257–1258.

    Article  PubMed  CAS  Google Scholar 

  14. Yunis AA, Miller AM, et al. Nitroso-chloramphenicol: Possible mediator in chloramphenicol-induced aplastic anemia. J Lab Clin Med 1980; 96:36.

    PubMed  CAS  Google Scholar 

  15. Nagao T, Mauer AM. Concordance for drug-induced aplastic anemia in identical twins. N Engl J Med 1969; 281:7–11.

    Article  PubMed  CAS  Google Scholar 

  16. Hodgkinson R. The chloramphenicol-hepatitis-aplastic anaemia syndrome. Med J. Aust 1973; 1:939.

    PubMed  CAS  Google Scholar 

  17. Casale TB, Macher AM, et al. Complete hematologic and hepatic recovery in a patient with chloramphenicol hepatitis-pancytopenia syndrome. J Pediatr 1982; 101:1025.

    Article  PubMed  CAS  Google Scholar 

  18. Yunis AA. Mechanisms underlying marrow toxicity from chloramphenicol and thiamphenicol. In: Silber R, LoBue J, et al, eds. The Year in Hematology. New York: Plenum, 1978: pp. 143–170.

    Google Scholar 

  19. Inman WHW. Study of fatal bone marrow depression with special reference to phenylbutazone and oxyphenbutazone. Br Med J 1977; 1:1500.

    Article  PubMed  CAS  Google Scholar 

  20. Heimpel H, et al. Aplastische anamien nach ennahme von phenylbutazone und oxyphenbutazon. Blut 1977; 33:208.

    Google Scholar 

  21. de Gruchy GC. Drug-Induced Blood Disorders. Oxford: Blackwell Scientific Publications, 1975.

    Google Scholar 

  22. Chang HK, Morrison SL. Bone marrow depression associated with Cimetidine. Ann Intern Med 1979; 91:58.

    Google Scholar 

  23. Rickert DE, et al. Benzene disposition in the rat after exposure by inhalation. Toxicol Appl Pharmacol 1979; 49:417.

    Article  PubMed  CAS  Google Scholar 

  24. Jenkens LJ, Jr, et al. Long-term inhalation screening studies of benzene, toluene, o-Xylene, and cumene on experimental animals. Toxicol Appl Pharmacol 1970; 16:818.

    Article  Google Scholar 

  25. Aksoy M, Erdem S, Dincol G, et al. Aplastic anemia due to chemicals and drugs: A study of 108 patients. Sexuality Transmitted Dis 1984; 11:347–350.

    Article  CAS  Google Scholar 

  26. Aksoy M, Erdem S. Follow-up study on the mortality and the development of leukemia in 44 pancytopenic patients with chronic exposure to benzene. Blood 1978; 52:285–292.

    PubMed  CAS  Google Scholar 

  27. Powars D. Aplastic anemia secondary to glue sniffing. New Engl J Med 1965; 273:700.

    Article  PubMed  CAS  Google Scholar 

  28. Crawford MAD. Aplastic anaemia due to trinitrotoluene intoxication. Br Med J 1954; 2:430.

    Article  PubMed  CAS  Google Scholar 

  29. Sanchez-Medal L, Castenedo JP, Garcia-Rojas F. Insecticides and aplastic anemia. N Engl J Med 1963; 269:1365.

    Article  PubMed  CAS  Google Scholar 

  30. Morley AA, Trainor KJ, Blake J. A primary stem cell lesion in experimental chronic hypoplastic marrow failure. Blood 1975; 45:681–688.

    PubMed  CAS  Google Scholar 

  31. Court-Brown WM, Doll R. Leukemia and aplastic anaemia in patients irradiated for ankylosing spondylitis. No. 295 of Special Report Series, Great Britain Medical Research Council, HM Stationery Office, London, 1957.

    Google Scholar 

  32. Lewis EB. Leukemia, multiple myeloma and aplastic anemia in American radiologists. Science 1963; 142:1492–1494.

    Article  PubMed  CAS  Google Scholar 

  33. Sykes MP, Savel H, Chu FCH, et al. Long term effects of irradiation upon bone marrow. Cancer 1964; 17:1144–1148.

    Article  PubMed  CAS  Google Scholar 

  34. Rubin P, Landman S, Mayer S, et al. Bone marrow regeneration after extended field irradiation in Hodgkin’s disease. Cancer 1973; 32:699.

    Article  PubMed  CAS  Google Scholar 

  35. Knospe WH, Rayudu VMS, et al. Bone marrow scanning with iron (Fe). Regeneration and extension of marrow after ablative doses of radiotherapy. Cancer 1976; 37:1432.

    CAS  Google Scholar 

  36. Young N, Mortimer P. Viruses and bone marrow failure. Blood 1984; 63:729–737.

    PubMed  CAS  Google Scholar 

  37. Lorenz E, Quaiser K. Panmyelopathie nach hepatitis epidemica. Wien Med Wochenschr 1955; 105:19–21.

    PubMed  CAS  Google Scholar 

  38. Bottiger LE, Westerholm B. Aplastic anemia-III. Aplastic anemia and infectious hepatitis. Acta Med Scand 1972; 192:323–326.

    Article  PubMed  CAS  Google Scholar 

  39. Aymard J-P, Guerci O, Herbeuval R. Infection-induced aplastic anemia. In: Najean Y, ed. Medullary Aplasia. New York: Masson, 1980: pp. 43–51.

    Google Scholar 

  40. Zeldiis JB, Deinstag JL, Gale RP. Aplastic anemia and non-A non-B hepatitis. Am J Med 1983; 74:64–8.

    Article  Google Scholar 

  41. Smith D, Gribble TJ, et al. Spontaneous resolution of severe aplastic anemia associated with viral hepatitis A in a 6-year-old child. Am J Hematol 1978; 5:247.

    Article  PubMed  CAS  Google Scholar 

  42. Casciato DA, Klein CA, Kaplowitz N, et al. Aplastic anemia associated with type B viral hepatitis. Arch Intern Med 1978; 138:1557–1558.

    Article  PubMed  CAS  Google Scholar 

  43. McSweeney PA, Carter JM, Green GJ, et al. Fatal aplastic anemia associated with hepatitis B viral infection. Am J Med 1988; 85:255–256.

    Article  PubMed  CAS  Google Scholar 

  44. Koppes GM, Ratkin GA, Coltman CA. Pancytopenia and “capillary leak syndrome” with infectious mononucleosis. South Med J 1976; 69:145–148.

    Article  PubMed  CAS  Google Scholar 

  45. Mir MA, Delamore IW. Aplastic anaemia complicating infectious mononucleosis. Scand J Haematol 1973; 11:314–318.

    Article  PubMed  CAS  Google Scholar 

  46. Van Doornik MC, Van’t Veer-Korthof ET, Wierenga H. Fatal aplastic anaemia complicating infectious mononucleosis. Scand J Haematol 1978; 20:1019–1028.

    Google Scholar 

  47. Rosse WF. Treatment of paroxysmal nocturnal hemoglobinuria. Blood 1982; 60:20–23.

    PubMed  CAS  Google Scholar 

  48. Ben-Bassat I, Brok-Somoni F, Ramot B. Complement-sensitive red cells in aplastic anemia. Blood 1975; 46:357–361.

    PubMed  CAS  Google Scholar 

  49. Jenkins DE, Hartmann RC. Paroxysmal nocturnal hemoglobinuria terminating in acute myeloblastic leukemia. Blood 1969; 33:274–282.

    PubMed  Google Scholar 

  50. Carmel R, Coltman CA, Yatteau RF, et al. Association of paroxysmal nocturnal hemoglobinuria with erythroleukemia. New Engl J Med 1970; 283:1329–1331.

    Article  PubMed  CAS  Google Scholar 

  51. Messerschmitt J, Desablens B. Aplastic anemia and pregnancy. In: Najean Y, ed. Medullary Aplasia. New York: Masson, 1980: pp. 61–65.

    Google Scholar 

  52. Ascensao J, Kagan W, Moore MAS, et al. Aplastic anaemia: Evidence for an immunological mechanism. Lancet 1976; 1:669–671.

    Article  PubMed  CAS  Google Scholar 

  53. Kagan W, Ascensao J, Pahwa R, et al. Aplastic anemia: Presence in human bone marrow of cells that suppress myelopoiesis. Proc Natl Acad Sei USA 1976; 73:2890–2894.

    Article  CAS  Google Scholar 

  54. Hoffman R, Zanjani ED, Lutton J, et al. Suppression of erythroid-colony formation by lymphocytes from patients with aplastic anemia. N Engl J Med 1977; 296:10–13.

    Article  PubMed  CAS  Google Scholar 

  55. Haak HL, Goselink HM. Evidence that certain human aplastic anemia may be caused by cell-mediated immune mechanism. Lancet 1977; 1:194.

    Article  PubMed  CAS  Google Scholar 

  56. Zoumbos NC, Gascon P, Djeu JY, et al. Circulating activated suppressor T lymphocytes in aplastic anemia. N Engl J Med 1985; 312:257–365.

    Article  PubMed  CAS  Google Scholar 

  57. Verma DS, Spitzer G, Gutterman JU. Human leukocyte interferon preparation blocks granulopoietic differential. Blood 1979; 54:1423.

    PubMed  CAS  Google Scholar 

  58. Kumpel GR, Fleischmann WR, Kumpel KD. Gamma interferon (IFN) and IFN suppress murine myeloid colony formation (CFU-C): Magnitude of suppression is dependent upon level of colony-stimulating factor (CSF). J Immunol 1982; 129:76–80.

    Google Scholar 

  59. Toretsky JA, Shahidi NT, Finlay JL. Effects of recombinant human interferon gamma on hematopoietic progenitor cell growth. Exp Hematol 1986; 14:182–186.

    PubMed  CAS  Google Scholar 

  60. Borden EC, Ball LA. Interferons: Biochemical cell growth inhibitory and immunological effects. In Brown EB, ed. Progress in Hematology XII. New York: Grune & Stratton, 1981: p. 299.

    Google Scholar 

  61. Urbaniak SJ, Halliday IM, Beveridge GW, et al. Neutropenia and thrombocytopenia after repeated course of leukocyte interferon. Lancet 1978; 1:553.

    Article  PubMed  CAS  Google Scholar 

  62. Mangan KF, Zidar B, Shadduck RK, et al. Interferon-induced aplasia: Evidence for T-cell-mediated suppression of hematopoiesis and recovery after treatment with horse antihuman thymocyte globulin. Am J Hematol 1985; 19:401–413.

    Article  PubMed  CAS  Google Scholar 

  63. Torok-Storb B, Johnson G, Bowden R, et al. Gamma-interferon in aplastic anemia: Inability to detect significant levels in sera or demonstrate hematopoietic suppressing activity. Blood 1987; 69:629–633.

    PubMed  CAS  Google Scholar 

  64. Hinterberger W, Adolf G, Aichinger G, et al. Further evidence for lymphokine overproduction in severe aplastic anemia. Blood 1988; 72:266–272.

    PubMed  CAS  Google Scholar 

  65. Laver J, Castro-Malaspina, Kernan NA, et al. In vitro interferon-gamma production by cultured T-cells in severe aplastic anaemia: Correlation with granu-lomonopoietic inhibition in patients who respond to anti-thymocyte globulin. Br J Haematol 1988; 69:545–550.

    Article  PubMed  CAS  Google Scholar 

  66. Tavassoli M, Crosby WH. Transplantation of marrow to extramedullary sites. Science 1968; 161:54.

    Article  PubMed  CAS  Google Scholar 

  67. Tavassoli M, Crosby WH. Bone marrow histogenesis: A comparison of fatty and red marrow. Science 1970; 169:291.

    Article  PubMed  CAS  Google Scholar 

  68. Knospe WH, Blom J, Crosby WH. Regeneration of locally irradiated bone marrow. 1. Dose dependent, long term changes in the rat with particular emphasis upon vascular and stromal reaction. Blood 1966; 28:396–415.

    Google Scholar 

  69. Crosizat H, Frindel E, Tubiana M. Proliferative activity of the stem cells in the bone marrow of mice after single and multiple irradiations (total or partial body exposure). J Radiat Biol 1970; 18:347.

    Article  Google Scholar 

  70. Frindel E, Croizat H, Vassort F. Stimulating factors liberated by treated bone marrow: In vitro effect on CFU kinetics. Exp Hematol 1976; 4:45.

    Google Scholar 

  71. Frindel E, Guigon M. Inhibition of CFU entry into cycle by a bone marrow extract. Exp Hematol 1977; 5:74.

    PubMed  CAS  Google Scholar 

  72. Lord BI, Mori KJ, Wright EG, et al. An inhibitor of stem cell proliferation in normal bone marrow. Br J Haematol 1976; 34:441.

    Article  PubMed  CAS  Google Scholar 

  73. Lord BI, Mori KJ, Wright EG. A stimulator of stem cell proliferation in regenerating bone marrow. Biomedicine 1977; 27:223.

    PubMed  CAS  Google Scholar 

  74. Wright EG, Lord BI. Production of stem cell proliferation regulators by frac¬tionated haemopoietic cell suspension. Leuk Res 1979; 3:15.

    Article  PubMed  CAS  Google Scholar 

  75. Wright EG, Lord BI. Production of stem cell proliferation stimulators and inhibitors by haemopoietic cell suspensions. Biomedicine 1978; 28:156.

    PubMed  CAS  Google Scholar 

  76. Dexter TM, Allen TD, Lajtha LG. Conditions controlling the proliferation of haemopoietic stem cells in vitro. J Cell Physiol 1977; 91:335.

    Article  PubMed  CAS  Google Scholar 

  77. Toksoz D, Dexter TM, Lord BI, et al. The regulation of hemopoiesis in long-term bone marrow cultures. II. Stimulation and inhibition of stem cell proliferation. Blood 1980; 55:931–936.

    CAS  Google Scholar 

  78. Ershler WB, Ross J, Finlay JL, et al. Bone marrow microenvironment defect in congenital hypoplastic anemia. N Engl J Med 1980; 302:1321.

    Article  PubMed  CAS  Google Scholar 

  79. Gale RP, Champlin RE, Feig SA, et al. Aplastic anemia: Biology and treatment. Ann Intern Med 1981; 95:477–494.

    PubMed  CAS  Google Scholar 

  80. Juneja HS, Gardner FH, Minguell JJ, et al. Abnormal marrow fibroblasts in aplastic anemia. Exp Hematol 1984; 12:221–230.

    PubMed  CAS  Google Scholar 

  81. Gordon MY, Gordon-Smith EC. Bone marrow fibroblast function in relation to granulopoiesis in aplastic anaemia. Br J Haematol 1983; 53:483–489.

    Article  PubMed  CAS  Google Scholar 

  82. Hotta T, Kato T, Maeda H, et al. Functional changes in marrow stromal cells in aplastic anaemia. Acta Haematol 1985; 74:65–69.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer-Verlag Inc.

About this chapter

Cite this chapter

Shahidi, N.T. (1990). Acquired Aplastic Anemia: Classification and Etiologic Considerations. In: Shahidi, N.T. (eds) Aplastic Anemia and Other Bone Marrow Failure Syndromes. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3254-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-3254-4_2

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7935-8

  • Online ISBN: 978-1-4612-3254-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics