Adult ; Anemia, Aplastic ; complications ; surgery ; Female ; Hematopoietic Stem Cell Transplantation ; Hemoglobinuria, Paroxysmal ; complications ; surgery ; Humans

Aplastic anemia is a hematopoietic disorder characterized by marked reduction or absence of erythoid, granulocytic, and megakariocytic cells in the bone marrow with resultant pancytopenia. To control of infection & bleeding secondary to leukopenia and thrombocytopenia, the inflammatory lesions in oral & maxillofacial area should be removed. MATERIALS AND METHOD: The extractions were performed on 21 patients with severe aplastic anemia. The initial, pre-operative and postoperative CBCs were checked up. Amount and kind of transfused platelet in each patient and increment of platelet level were recorded. The complications were documented. RESULT: A mean of 2.9 teeth were extracted from each patient(ranging between 1 and 13). Furthermore, surgical extractions including ostectomy and odontectomy of the third molar were performed on 11 patients. The preoperative WBC levels presented between 600/muL and 5000/muL(mean 2376/muL). The WBC values decreased by an average of 145/muL per patient after extractions had been performed. The teeth of 16 patients were extracted under 10.0g/dL, and the mean change in postoperative hemoglobin levels in comparison with preoperative hemoglobin levels was -0.06 per patient. The initial platelet levels were between 1000/(L and 81,000/muL(mean 20,174/muL). In five patients, extractions were performed with platelet levels less than 50,000/muL. CONCLUSION: The results suggest that more active and preventive treatments in the oral and maxillofacial area are possible and are necessary to remove the infectious foci on the patients with severe aplastic anemia. We report the results of our experiences and literature reviews in treatment of the patients with severe aplastic anemia in our department.
Anemia, Aplastic* ; Blood Platelets ; Bone Marrow ; Hemorrhage ; Humans ; Leukopenia ; Molar, Third ; Pancytopenia ; Surgery, Oral* ; Thrombocytopenia ; Tooth

Anemia, Aplastic ; drug therapy ; immunology ; surgery ; therapy ; Bone Marrow Transplantation ; Child ; Humans ; Immunosuppressive Agents ; therapeutic use ; Treatment Outcome

Anemia, Aplastic ; complications ; surgery ; Bone Marrow Transplantation ; Child ; Hepatitis E ; complications ; surgery ; Humans ; Liver Failure, Acute ; complications ; surgery ; Liver Transplantation ; Male ; Tissue Donors ; Treatment Outcome

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.
Adenocarcinoma/*complications/secondary/surgery ; Anemia, Aplastic/*complications/drug therapy ; Case Report ; Human ; Male ; Middle Age ; Oxymetholone/therapeutic use ; Stomach Neoplasms/*complications/surgery

Major surgery in a patient with pancytopenia might be associated with increased surgical risks, especially for bleeding and infection. A 66-yr-old man was admitted to the hospital due to shortness of breath. His dyspnea was classified by the New York Heart Association (NYHA) as functional class III. Prior to admission, he had a 5-yr history of medical management for idiopathic aplastic anemia. The severity of aplastic anemia of the patient was graded as non-severe aplastic anemia. Echocardiography revealed reduced left ventricular function and severe aortic valve regurgitation (grade IV) with left ventricular end diastolic dimension measuring 87 mm. Because of dyspnea and echocardiographically documented aortic valve insufficiency, the patient underwent elective aortic valve replacement. Although extracorporeal circulation for valve operations might be associated with aggravation of impaired blood cell function, the patient recovered from surgery uneventfully. Here, we report a successful cardiac surgery with extracorporeal cardiopulmonary bypass in a patient with severe aortic valve insufficiency and concomitant idiopathic aplastic anemia.
Aged ; Anemia, Aplastic/*surgery/*therapy ; Anticoagulants/therapeutic use ; Aortic Valve/pathology ; Aortic Valve Insufficiency/*surgery ; *Cardiac Surgical Procedures ; Echocardiography/methods ; Heart Valve Prosthesis ; Humans ; Male ; Treatment Outcome

Objective of this study was to evaluate the efficacy and safety of haploidentical or unrelated donor hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA). Twenty patients with SAA received allogeneic HSCT from haploidentical or unrelated donors (14 from haploidentical donors and 6 from unrelated donors) from November 2005 to May 2011. Conditioning regimen consisted of fludarabine (FLU), cyclophosphamide (Cy) and anti-thymocyte immunoglobulin (ATG). The patients were administrated with G-CSF-primed bone marrow and mobilized peripheral blood as grafts from haploidentical donor or only mobilized peripheral blood from the unrelated donor. The results showed that the median time of neutrophil and platelet engraftment were 14 (11 - 20) d and 17 (13 - 31) d respectively. All patients who achieved engraftment had complete hematologic recovery with complete donor chimerism, except for two patients who developed graft failure in 2 months after transplantation. Four cases developed acute grade IIGVHD. The chronic GVHD occurred in 7 of the 16 evaluable cases (6 limited, 1 extensive). 14 patients got disease-free survival with follow-up to January 2012. The disease-free survival rate was 68.9%. It is concluded that the haploidentical or unrelated donor hematopoietic stem cell transplantation may become a viable therapeutic option for severe aplastic anemia patients who lack suitable human leukocyte antigen-matched donors and fail immunosuppressive therapy.
Adolescent ; Adult ; Anemia, Aplastic ; surgery ; Child ; Child, Preschool ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Transplantation Conditioning ; methods ; Transplantation, Homologous ; Unrelated Donors

OBJECTIVETo explore the effect of bone morphogenetic protein (BMP) to activate mesenchymal stem cells of skeletal muscle for rescuing bone marrow failure.

METHODSThe study was performed on lethal rat acute aplastic anemia model induced by combined 5-fluorouracil (5-FU) and busulfan. The rh-BMP-2 was implanted into the thigh muscle of the rats at 3 days before aplastic anemia was induced. In the control group the rats were implanted with agar into the thigh muscle. The blood picture, pathologic changes and the mortality in two groups were observed. At the same time, rh-BMP-2 were implanted into the thigh muscle of normal Kun-min mice for dynamic control observation of the implantation local morphological changes, colony forming units-spleen (CFU-S) and stem cell growth factor (SCF) expression of the stroma cells of ectopic ossicles induced by BMP.

RESULTSAt 7 days after BMP implantation in the mice the mesenchymal cells around BMP in muscle proliferated, and appeared in bone marrow to form an ectopic ossicles. The SCF expression of stroma cells in ectopic ossicles were higher than that of self-bone marrow. 56.3% of BMP-treated aplastic rats were survived over 3 months and its hematopoiesis was completely reconstituted and the histo-morphological picture of the spleen and bone marrow were recovered to normal. But in the control group only one of 23 rats was survived, the remainder died of hematopoietic failure.

CONCLUSIONSBMP-implantation into the skeletal muscle could rescue the bone marrow hematopoietic failure. The mechanism might be related to the BMP activated auto-mesenchymal cells of skeletal muscles to direct hematopoietic cell differentiation. In our hands it might create a new pathway for utilization of auto-muscle derived mesenchymal cells to reconstitute hematopoiesis.

Anemia, Aplastic ; chemically induced ; pathology ; therapy ; Animals ; Bone Morphogenetic Proteins ; therapeutic use ; Busulfan ; Cell Differentiation ; Female ; Fluorouracil ; Hematopoiesis ; Hematopoietic Stem Cells ; cytology ; Implants, Experimental ; Male ; Mice ; Muscle, Skeletal ; surgery ; Rats ; Rats, Wistar ; Recombinant Proteins ; therapeutic use ; Stem Cells ; cytology

Aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy. We present a case of a 60-year-old woman with very severe aplastic anemia appearing sixteen months after thymectomy for a thymoma. She underwent thymectomy for a thymoma in April 2000. Preoperative examination revealed no hematologic abnormality. About sixteen months after the operation, she was readmitted because of pancytopenia with cough and fever. Bone marrow aspiration revealed a very severe hypoplasia in all the three cell lines with over 80% fatty tissue, and chest CT revealed no recurrence of thymoma. Her aplastic anemia had responded to cyclosporine A and granulocyte-colony stimulating factor (G-CSF).
Anemia, Aplastic/drug therapy/*etiology/*pathology ; Biopsy, Needle ; Bone Marrow/pathology ; Cyclosporine/administration & dosage ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Granulocyte Colony-Stimulating Factor/administration & dosage ; Humans ; Middle Aged ; Rare Diseases ; Risk Assessment ; Severity of Illness Index ; Thymectomy/*adverse effects/methods ; Thymoma/diagnosis/*surgery ; Treatment Outcome

No abstract available.
Adult ; Anemia, Aplastic/*surgery ; Antiprotozoal Agents/therapeutic use ; Drug Therapy, Combination ; Encephalitis/diagnosis/drug therapy/*parasitology ; Female ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Immunosuppressive Agents/adverse effects ; Magnetic Resonance Imaging ; Parasitology/methods ; Polymerase Chain Reaction ; Republic of Korea ; Toxoplasma/genetics/*isolation & purification ; Toxoplasmosis, Cerebral/diagnosis/drug therapy/*parasitology ; Transplantation, Homologous ; Treatment Outcome