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Why is my friend's body not producing new cells?

Q: One of my friends had been diagnosed with a disease where his body can't develop new cells. He had been told that the new cell-producing agent (some chemical liquid inside our body) is not functioning. He had been told to count the days since there is no cure for this. What is the name of this disease? Is there any treatment of the same in India or abroad?

A:I think you are referring to aplastic / hypoplastic anaemia. This is a condition in which there is bone marrow failure that is characterized by anaemia (low haemoglobin), leukopaenia (low white cell count) and thrombocytopenia (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 thrombocytopenia). 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 is available in most major hospitals and your friend should consult a haematologist. 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, ATG and 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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