There were great break through in the studies on aplastic anemia in China during the past 20 years.The annual incidence of aplastic anemia in China was about 0.73 per one hundred thousand population.The risk factors,particularly virus infection,were associated with the onset of aplastic anemia. The pathogenesis of aplastic anemia was recognized as that the marrow failure was resulted mainly by autoimmunic T cell attack through lymphokine induced apoptosis.Aplastic anemia,an autoimmunic marrow failure rather than marrow failure syndromes,should be diagnosed based on marrow failure,T cell over function and exclusion of other similar diseases.Long enough intensive immunosuppressive therapy combined with hemopoietic stimulating factors was proven to be effective on aplastic anemia which might be cured.

Idiopathic bone marrow failure anemia(BMF),a group of severe hematopoietic diseases including acquired aplastic anemia,pure red cell aplasia,immune related pancytopenia,immune related anemia,paroxysmal nocturnal hemogobinurea,myelodysplastic syndromes and idiopathic cytopenia of undetermined significances,is quite easy to be misdiagnosed clinically.The proper diagnoses of these diseases should be made on the complete and detailed information about the patient's symptoms and signs,results of regular blood tests,bone marrow morphology examination and investigations on the pathogenesis of BMF,and response to the tentative therapy if it is necessary.High curative rate of these diseases will be achieved with prompt and long enough therapies for supporting patient's life,blocking the pathogenic process and stimulating hematopoiesis.

Aplastic anemia(AA)is a life-threatening blood disease.The British guideline and Chinese experts' experiences indicate that it is related to the abnormality of cellular immunity.Diagnosis by adequate exclusion,strict indication for stem cell transplantation and more immunosuppression plus hematopoietic stimulating therapies should be paid more attention in the treatment of this disease.

Myelodysplastic syndrome (MDS) comprises a heterogeneous group of malignant disorders.The diagnosis of MDS has always been the focus of attention of hematologists all over the world.From the FAB classification to 2008 WHO classification,the diagnosis of MDS has changed from completely morphological diagnosis to multi-parameter diagnosis.Nowadays,the diagnosis of MDS should involve multiple parameters concerning morphology,histochemistry,cytogenetics and immunology.

Abnormal epigenetics play important roles in the pathogenesis of myelodysplastic syndromes (MDS). DNA hypermeth-ylation is the most common epigenetic abnormality in MDS. Demethylating DNA hypermethylation may improve the quality of life of MDS patients and prolong their overall survival. Azacitidine and decitabine are the demethylating drugs approved for MDS treatment. These drugs showed clinical effects on all subgroups of MDS patients.

[Abstrct] Based on field studying at University of California, Los Angeles (UCLA),discussing with the teacher and student representatives and reviewing related literatures, we found that the suc-cessful experience of PBL at UCLA were small group teaching, the use of different sources of tutor, serious case preparation, and good hardware support. The major difficulties of PBL at UCLA were high teaching costs, unstable teacher group and high hardware requirements. Because of the cultural differ-ences between East and West, Chinese students are not good at active learning, so we recommended gradually carrying out PBL teaching in our country, making more PBL skills training to teachers and students, strengthening the hardware construction, seeking school administrative support, and giving timely repair according to the feedback of scientific research.

Anemia is one of the most common complication and a negative prognostic factor of lymphoid neoplasma.Different cases with lymphoid neoplasma associated anemia(LNAA)have various pathogenesis such as hemorrhagic anemia, anemia of chronic disease,autoimmune hemolytic anemia and treatment related anemia, though they all have the same symptoms. So different regimens are given to different patients according to their pathogenesis of LNAA.

Objective To study the clinical and laboratory features of the patients with immunorelated pancytopenia(IRP).Methods The risk factors,manifestations,blood cell counts,bone marrow phenotypes,autoantibodies and immunosuppressive therapy response of 72 patients with IRP were analyzed.Then they were followed up for(6 ~36)months,to see their long-term outcome and the prognostic factors.Results The infection,anaphylaxis and pregnancy were highly suspected to be the risk factors of IRP.Most of these patients were with pancytopenia72.2%(52/72);91.7%(66/72)of them were anemic with large or normal MCV;75.0%(54/72)of them were with leukopenia;18.1%(13/72)of them had fever.Thrombocytopenia was common,but serious bleeding rare.68.1% of these cases were with normal or decreased bone marrow cellularities and increased normoblasts.They were all found to have positive results of bone marrow mononuclear cell Coombs test,negative results of routine hemolysis tests and no evidence of malignant clonal hematopoiesis.42.9%(18/42)of these patients had C3 decreased,and 19.0%(8/42)C4 decreased.Immunosuppressive therapy was administered to 72 IRP patients.The response rate at 36 months was 87.5%(28/32).Conclusion IRP is a blood disease induced by acquired autoantibodies mediated bone marrow inhibition or destruction.It manifests pancytopenia with relative higher percentages of reticulocytes and neutrophils,and responds well to immunosuppressive therapy.

Objective To explore the clinical features of sev er e aplastic anemia (SAA) patients with chronic hepatitis B virus (HBV) infection.Methods 737 SAA cases newly diagnosed in the institute of Hemat ology and Blood Disease Hospital,CAMS in recent 13 years (1991 ~ 2003) were anal yzed.The ratio of SAA patients with chronic hepatitis B (21 cases,group Ⅰ) in them was investigated.A case-control study was undertaken to investigate the di fferences of clinical and laboratory features、therapeutic effectiveness and pro gnosis between SAA patients with chronic HBV infection \[the cases with chronic hepatitis B and those with antibodies to hepatitis virus B (23 cases,group Ⅱ )\] and SAA control group (42 cases,group Ⅲ ).Results ①The ratio of SAA patients with chronic hepatitis B in all SAA was 2.8%.②There was no significant difference of clinical features am ong them before treatment.③The recovery of PB counts、bone marrow hematopoiesis of group Ⅰ was slower than that of group Ⅱ and group Ⅲ after treatment.Th e percentage of CD8 + cells of group Ⅰor Ⅲwas significantly higher than that of group Ⅱ (P

Objective To analyze the incidence,severity and morphologic characteristics of anemia in patients with malignant tumors.Methods Five hundred and thirty hospitalized patients with a primary diagnosis of tumor were enrolled in this study at our hospital from Jan.2009 to Mar.2011.Their hemoglobin (Hb) levels,age,sex,and type of tumor were recorded.Anemia was diagnosed to be present when their Hb on admission was less than 110 g/L Results There were 111 in the 530 patients (20.94％) had anemia on admission.Anemia was seen in 35.3％ of patients with digestive system cancer,in 19.4％ with gynecologic cancers,in 18.3％ withlung cancers,in 6.8％ with urinogenital cancers and 1.8％ with breast cancers.The difference of incidence of anemia in different types of cancers was statistically significant ( x2=44.9785,P ＜ 0.01 ).Grade Ⅰ and Ⅱanemia accounted for 15.66％ ; and grade Ⅲ and Ⅳ accounted for 5.28％ of all.There was no significant difference of incidence of anemia between male and female [ 22.36％ ( 72/322 ) vs.18.75％ ( 39/208 ),x2 =1.0020,P ＞ 0.05 ].The more severe the anemia was,the smaller the erythrocyte mean corpuscular volume was.The rate of anemia was 2.08％ when patients were discharged,and 5.66％ were intervened.Conclusion The incidence of anemia was high in patients hospitalized with tumor,but only a small percent got enough medical care.