Association of Various Etiological Factors with Idiopathic Acquired Aplastic Anemia

Abstract

Objective: To determine demographic features, clinical features and association of various etiological factors in patients of idiopathic acquired aplastic anemia in local population at the time of diagnosis.

Patients and Methods: This cross sectional study was conducted in Department of Haematology, Pakistan Institute of Medical Sciences Islamabad and Department of Genetics, Children Hospital Lahore, from June 2015 to July 2017. Total 64 cases of peripheral blood pancytopenia having clinical suspicion of acquired aplastic anemia were enrolled in the study. Patients with congenital aplastic anaemia, patients with features of bone marrow dysplasia and abnormal infiltrates and patients with post chemotherapy and radiotherapy aplasia were identified and excluded from the study. Sixty patients diagnosed to have acquired aplastic anaemia on the basis of clinical features, peripheral blood and bone marrow findings, were included in this study as per inclusion criteria.

Results: Among 60 diagnosed cases of acquired aplastic anaemia, 34 were male and 26 were female with a male to female ratio of 1:1.30. Age distribution of study participants ranged from 1 to 84 years with a median age of 10 years. Most of the patients (73.3%) presented with non severe stage of disease. Different etiological factors reported to be implicated in acquired aplastic anaemia in the patients of this study were Viral infections (hepatitis B & hepatitis C), Mycobacterial infection, Fertilizers & Pesticides, Chemicals & Toxins, Ionizing radiations, Autoimmune diseases (Rheumatoid arthritis & Systemic lupus erythematosus), Transfusion associated GVHD, Pregnancy, Drugs (Analgesics & Hypoglycemics) and Cigarette smoking. In 14 out of 60 patients (23.3%) various etiological factors were found to be associated with idiopathic acquired aplastic anaemia.

Conclusion: Aplastic anaemia was seen in patients of all ages and both genders were equally affected. Non severe aplastic anaemia was most common stage of the disease. Pallor, bleeding and fever were common clinical features. Etiological factors could not be identified in majority of the patients, however various etiological factors have been reported to be associated with increased risk of acquired aplastic anaemia. Identification and treatment of underlying cause may be beneficial in the management of patients with acquired AA. It may also guides in prevention of the disease.