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What is the treatment for aplastic anaemia?

Q: My girlfriend has anaemia. After months of blood tests and bone marrow biopsy the doctor said that her own immune system is attacking her red blood cells. He prescribed 30 mg of prednisolone per day. The situation has improved but I know that this medicine cannot cure the same.

A:The anaemia you are referring to is likely aplastic / hypoplastic anaemia. This is a condition in which there is bone-marrow failure that is characterised by anaemia (low haemoglobin), leukopaenia (low white cell count) and thrombocytopaenia (low platelet count). The bone marrow is hypoplastic and shows large fat cells with marked reduction in normal blood forming cells. The problems due to this disease relate to infection (due to low white cell count) and bleeding (because of thrombocytopaenia). It is postulated that the disease arises due a defect in or damage to bone marrow stem cell, the cell which gives rise to all other blood cells. The condition is usually acquired and is presumed to be an autoimmune disease but it may also be secondary to some infections or exposure to drugs and chemicals. Treatment includes transfusions, treatment of infections and immunosuppressive therapy. The definitive treatment is a bone marrow transplant (BMT) from an HLA-matched sibling but this too has a rejection rate of about 10%. Immunosuppressive therapy is planned if BMT is not possible. This includes the use of steroids, anti-thymocyte globulin (ATG) and cyclosporin (CSA). The response to treatment is slow and may take upto 3 months after initiating therapy. Following this initial response, there is slow improvement. About 50% patients respond by 3 months after ATG administration, and about 75% respond by 6 months. Most patients improve and become transfusion independent, but bone marrow changes may persist. Relapse is common and patients often need continued immune suppression. Several studies have shown that the addition of cytokines (e.g. G-CSF, GM-CSF) may hasten the neutrophil recovery. The estimated 5-year survival of a patient on immunosuppression is about 75%.

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