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Anca Colita
ANEMIA APLASTICA
Anemia aplastică este o afectiune severa, potential
fatala, în care producția de eritrocite, leucocite și
trombocite este foarte scazuta.
Factori de crestere
Transplant medular
Imunosupresie Suportiv
TRATAMENT
1. identificare agent etiologic
2. tratament suportiv
Transfuzii izogrup izogrup , cu produse iradiate,
leucodepletate
Antibiotice, antifungice
3. allotransplant de celule stem hematopoietice
-donator inrudit
-Curative in 60-90% cazuri
-aplicabil la 30% DIN CAZURI
4. Imunosupresie
Cyclosporin + ATG
Corticosteroids
High dose cyclophosphamide
5. Factori de crestere
G-CSF/ GM-CSF/ EPO
AA - prognostic
Varst: Younger is better
BMT
< 20 ani cu donator familial… 75%
20 - 40 ani cu donator familial …60%
< 20 ani cu donator nonfamilial … 40%
20 - 40 cu donator nonfamilial T…35%
Immunosuppression - 60 - 80%
- Pentru cat timp si cu ce consecinte…
Sdr de insuficienta medulara
congenitala
Boli rare
Hematopoieza afectata
Predispozitie pentru cancer
+/- anomalii congenitale
Varsta la diagnostic
copil
Adult
Dg dif cu AA dobandite este critica pentru tratament
Sdr de insuficienta medulara
congenitala
Multilineala Unilineala
FANCONI ANEMIA DIAMOND BLACKFAN
(FA) ANEMIA (DBA)
DYSKERATOSIS SHWACHMAN
CONGENITA (DSC) DIAMOND (SDS)
AMEGAKARIOCYTIC
THROMBOCYTOPENIA
VERY RARE DISEASES:
Kostman sdr, CDA, Dubowitz sdr, Seckel sdr,
Pearson sdr, Cartilage Hair hypoplasia (CHH),
Reticular digenesis, TAR
Ribosomopathies: DC, CHH, DBA, SDS
RIBOSOM
-A large complex molecule
responsible for catalyzing
the formation of proteins
from individual aminoacids
using mRNA as a template.
-1974: Palade GE, Claude A.,
De Duve C. – Nobel Prize in
Physiology and Medicine for
the discovery of the
ribosome
-2009: Rasmakrishanan V,
Stritz TA, Yonath AE – Nobel
Prize in chemistry for
discovery the detailed
structure and mechanism of
the ribosome
Potential mechanisms for the cellular consequences of ribosomal haploinsufficiency.
Top panel: Normal cell in unstressed conditions, with unperturbed ribosome biogenesis and steady levels of p53.
Bottom panel: Ribosomal haploinsufficiency leads to up-regulation of rpL11, which binds to MDM2 causing p53 activation,
which results in apoptosis and cell-cycle arrest.
Kumar S, Bandyopadhyay U. Free heme toxicity and its detoxification systems in human. Toxicol Lett. 2005;157(3):175-188.
Telomeropathies: a newly described group of human diseases based
on the genetics and molecular biology of the telomeres
• Telomeres, the ends of chromosomes, are repeated
hexanucleotides and their associated proteins;
• They protect chromosomes from recognition as damaged DNA
• When telomeres become critically short in a cell, senescence,
apoptosis, or, rarely malignant transformation results.
In individuals with mutations in genes involved in telomere
repair, severe deficiencies result in dyskeratosis congenita, a
congenital aplastic anemia with associated mucocutaneous
abnormalities.
Mutations in TERT (the catalytic component) and TERC (the
RNA template) = risk factors for the development of bone
marrow failure, pulmonary fibrosis, and hepatic cirrhosis.
Chromosome instability is a result of critical shortening of
telomeres
Dokal I, Hematology 2011
Sdr de insuficienta medulara
congenitala
► anamneza
► statura mica / nanism
► hiperpigmentatie
► Rash
► displazie ungheala
► Leukoplakia
► insuficienta de pancreas exocrin
► anomalii de schelet (radius, degete)
► alte anomalii congenitale
Hematologie
Citopenii periferice
severe/moderate sau
absente
FA Pancytopenia Macrocytosis HbF ↑
DC Pancytopenia Macrocytosis HbF ↑
Macrocitoza
SDS Neutropenia HbF ↑
inexplicabila
DBA Anemia Macrocytosis HbF ↑
NOP10, 15q14 ٥ AA
TERT, 5p15
▪ AR ٥ Solid
NHP2, 5q35 tumours/MSD/Leukemia
TCAB1,
C16orf57 17p13.1
16q21
HEREDITARY BONE MARROW FAILURE
Disease Gene Chromosome Fenotype
Transmision
٥ Erythroblastopenia
DBA
٥ Erythrocytic ADA↑
▪ AD RPS 19
19q 13 ٥ Congenital anomalies (30%,
▪ (AR?) (25%) thumbs, upper limbs, cranio facial,
heart, uro-genital)
Shwachman ٥ AA
▪ AR SBDS 7q 11 ٥ Exocrine pancreas insufficiency
E.Gluckman,2004
Guido Fanconi