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Factor income
chemicals such as insecticides and heavy metals are also associated with
Radiation
Drugs
the stem cells and progenitor cells damaged. Radiation can damage DNA
excessive drug dose. Practically all the drug can cause aplastic anemia in
When the stem cells were exposed to the hematopoiesis occurs aplastic
anemia. Radiation can also affect the bone marrow stroma and cause
fibrosis.2
example
Infection
cytotoxic
drugs
mieleran
or
nitrosourea.2
damage is not about the radiation field as long as most of the bone
hepatitis, Epstein-Barr virus, HIV and rubella. Viral hepatitis is the most
frequent cause. Severe pancytopenia may occur one to two months after
cell count can be reduced reversibly in radiation dose between 1 and 2.5
Sv (100 and 250 rads). Irreversible loss of stem cells occurs at higher
radiation doses. Even patients can die due to damage to the bone marrow
Chemical Substances
bone
marrow,
usually
looks
little
sparse
neutropenia
and
D. Pathophysiology
The cause of aplastic anemia is difficult to determine, especially
2. Genetic Factors
sure then classified into the causes idiopatik.10 Another opinion states that
the most common cause of bone marrow failure are iatrogenic due to
cytostatic chemotherapy or therapy radiasi.9,10
Damage that occurs in aplastic anemia found on stem cells and the
inability of the bone marrow tissue to allow the stem cells to grow and
and limpa.2
microenvironment
Pregnancy
(microenvironment)
in
the
bone
marrow.
Cases of pregnancy with aplastic anemia have been reported, but the
activate citometry flow, which can detect antigen CD34 + cells and
would improve again after giving birth. In other cases, aplasia occurs
F. Diagnosis
peripheral blood. This condition cause complaints pale, bleeding and fever
of T cells via the Fas receptor-ligand fas cause the target cell apoptosis.
gene transcription and entry into the cell cycle. IFN- also induces the
E. Clinical Manifestations
there are a lot of connective tissue and fat tissue, the system aplasi
1. Pale
eritropoetik,
2. Weakness
G. Prognosis
3. Rash
granulopoetik
and
trombopoetik.5
4. Shortness of breath
bad, because as has been stated both etiology and pathophysiology as yet
5. Easy bruising
6. Nose bleed
diagnosis, less than 10-20% healed without a bone marrow transplant and
7. Bleeding gums
a third patient died from bleeding and infection are not resolved. Cause of
8. dispneu
9. Anorexia
sesuai.5
aplastic anemia is bad if discovered at a young age, the image of the bone
blood with the reticulocyte count <1%, leukocytes <500 / uL, and platelets
the top of the most well be used as guidance in determining the prognosis
H. Procedures
and good dental care is very important, because infections are usually
severe and often the cause of death. Aplastic anemia in patients whose
Management of supportive
causes fever bakteni therapy continued until 10-14 days or until the
cultures are negative. If fever persists for up to 48 hours after being given
prevent graft- versus host disease (GVHD). This transfusion can take place
may be the cause. If chemicals or toxic physics was discovered and still
Management of Medical
1. Drugs
with mild aplastic anemia, patients who did not get a suitable donor for
3. Immunosuppressant
Methylprednisolone
2. Androgen
Androgens are used for the treatment of aplastic anemia since 1960.
intravenously for 8 days and then proceeded tappering with a dose of 1mg
/ kg body weight / day for 9-14 days, then tappering during 15-29 day.
use of a single androgen as aplastic anemia therapy did not increase the
adjunct therapy androgen antitymocyte globulin (ATG) also did not show
improve hematologic response but did not increase the survival rate.
will reduce lymphocytes circulating that reduced 10%, and when the total
promotes
the
secretion
of
several
factors
pertumbuhan.4,11,17
Can also be given a dose of 20mg / kg body weight / day for 4-6 hours by
single
ALG
approximately
50%
.5
effects. If found toxic effects, the therapy is stopped for 1-4 days followed
remission
Contraindications
Cyclophosphamide (CPA)
trombositopenia.17
are
state
hypersensitivity
reactions,
leukopenia
system
approximately
70%
.5
between
(TST) reported that in 155 adult patients with aplastic anemia treated with
link DNA may be associated with normal cell growth and neoplasma.17
weight / day for 4 consecutive days. But keep in mind that high doses are
given will increase tosik serious effects and therapeutic effects posed no
death awal.5
severe aplastic anemia with CPA 45mg / kg body weight / day for 4 days,
Cyclosporin A (Cs A)
outcome
or
hematopoietic
giving
the
result
is
more
effective
than
other
conventional
severe aplastic anemia who had a younger brother with HLA match.
/ kg body weight / day for 4 days showed a high dose CPA therapy without
TST make free remission in patients with severe aplastic anemia. This
sebagan patients (only about 30% of patients who have the HLA-matched
study was conducted in patients who can not be done marrow transplant
tulang.5
therapy has not been ascertained, but the 35-year-old patient who better to
as well the incidence and severity of bone marrow donor rejection reaction
(Graft Versus Host Disesase / GVHD). Patients with age> 40 years proved
to
Patients who receive bone marrow transplants have better survival than
/ kg body weight / day for 4 days with ATG and 10-12 mg / kg body
survival of patients who received bone marrow transplanasi but it has been
received
far as possible be taken from donors not as a potential bone marrow donor.
have
poorer
response
immunosuppressive
than
younger
therapy
patients.
altogether.
and
mm3.
blood is an alternative which may be a source of stem cells for the TST in
2000
donor and recipient related. TST complication that occurs most frequently
mm3
platelets
and
at
platelets
least
below
100,000
100,000
who underwent TST with a donor unrelated, it was concluded that the cord
mm3.
- Refractory: no improvement.
patients without recurrent transfusions have a better response around 8595% because the lymphocytes of these patients have not been sensitized by
syndromes and acute leukemia is higher than the TST. From the report of
studies that have been done, the impact of long-term treatment of aplastic
with aplastic anemia showed that TST causes normal hematopoiesis into
anemia are at high risk for the case of solid tumors, myelodysplastic